.  ..w^o^fe"-^>EP: 


PUBLIC 
HEALTH 
UBRARY 


THE  UNIVERSITY  OF  CHICAGO 
SCIENCE  SERIES 


Editorial  Committee 

ELIAKIM   HASTINGS   MOORE,    C/iairman 

JOHN  MERLE  COULTER 

ROBERT  ANDREWS  MILLIKAN 


The  University  of  Chicago  Science  Series, 
established  by  the  Trustees  of  the  University, 
owes  its  origin  to  a  feeling  that  there  should  be 
a  medium  of  publication  occupying  a  position 
between  the  technical  journals  with  their 
short  articles  and  the  elaborate  treatises  which 
attempt  to  cover  several  or  all  aspects  of  a 
wide  field.  The  volumes  of  the  series  will 
differ  from  the  discussions  generally  appearing 
in  technical  journals  in  that  they  will  present 
the  complete  results  of  an  experiment  or  series 
of  investigations  which  previously  have  appeared 
only  in  scattered  articles,  if  published  at  all. 
On  the  other  hand,  they  will  differ  from  detailed 
treatises  by  confining  themselves  to  specific 
problems  of  current  interest,  and  in  presenting 
the  subject  in  as  summarj^  a  manner  and  with 
as  little  technical  detail  as  is  consistent  with 
sound  method. 


FOOD  POISONING 


THE  UNIVERSITY  OF  CHICAGO  PRESS 
CHICAGO,  ILLINOIS 

Bgents 

THE  BAKER  &  TAYLOR  COMPANY 

NEW  YORK 

THE  CUNNINGHAM,  CURTISS  &  WELCH  COMPANY 

LOS  ANOBLES 

THE  CAMBRIDGE  UNIVERSITY  PRESS 

LONDON  AND  EDINBURGH 

THE  MARUZEN-KABUSHIKI-KAISHA 

TOKYO,  OSAKA,    KYOTO,   FUKUOKA,  SENDAI 

THE  MISSION  BOOK  COMPANY 

SHANSHAI 


FOOD  POISONING 


By 


EDWIN  OAKES  JORDAN 

Chairman  of  the  Department  of  Hygiene  and  Bacteriolo 
The  Unii'crsity  of  Chicago 


THE  UNIVERSITY  OF  CHICAGO  PRESS 
CHICAGO,  ILLINOIS 


CoPViiGUT  1917  By 
The  Universit  v  3f  Chicago 


All  Rights  Reserved 


.     \  to.  Published  May  1017 


Composed  and  Printed  By 

The  University  of  Chicago  Press 

Chicaeo,  Illinois,  U.S.A. 


CONTENTS 

HAPTER  PAGE 

I.  Introduction i 

The  Extent  of  Food  Poisoning 

Various  Kinds  of  Food  Poisoning 

The  Articles  of  Food  Most   Commonly  Connected 

with  Food  Poisoning 

II.  Sensitization  to  Protein  Foods g 

III.  Poisonous  Plants  and  Animals    .......       13 

Poisonous  Plants 

Poisonous  Animals 

IV.  Mineral  or  Organic  Poisons  Added  to  Food  .      .       26 
Arsenic 

Antimony 

Lead 

Tin 

Copper 

Various  Coloring  Substances 

Food  Preservatives 

Food  Substitutes 

V.  Food-borne  Pathogenic  Bacteria 44 

Typhoid  Food  Infection 

Asiatic  Cholera 

Tuberculosis 

Various  Milk-borne  Infections 

Possible  Infection  with  B.  proteus 

VI.  Food-borne  Pathogenic  Bacteria  {Continued)       .       58 
Paratyphoid  Infection 

Typical  Paratyphoid  Outbreaks 

General  Characters  of  Paratyphoid  Infection 

Toxin  Production 

Sources  of  Infection 

Means  of  Prevention 


3G0514 


viii  CONTENTS 

CHAPTER  PAGE 

VII.  Animal  Parasites 7q 

Trichiniasis 
Teniasis 
Uncinariasis 
Other  Parasites 

VIII.  Poisonous  Products  Formed  in  Food  by  Bacteria 

AND  Other  Micro-organisms 85 

Ergotism 
Botulism 

Symptoms 

Anatomical  Lesions 

Bacteriology 

Epidemiology 

Prevention  and  Treatment 
Other  Bacterial  Poisons 
Spoiled  and  Decomposed  Food 

IX.  Poisoning  of  Obscure  or  Unknown  Nature    .     .     100 
Milkslckness  or  Trembles 
Deficiency  Diseases 

Beriberi 

Pellagra 

Lathyrism 

Favism 

Scurvy 

Rachitis 
The  Foods  Most  Commonly  Poisonous 

Index 109 


CHAPTER  I 
INTRODUCTION 

How  frequently  food  poisoning  occurs  is  not  def- 
initely known.  Everybody  is  aware  that  certain  ar- 
ticles of  food  are  now  and  again  held  responsible  for 
more  or  less'  severe  "attacks  of  indigestion"  or  other 
physiological  disturbances  that  have  followed  their 
consumption,  but  in  many  cases  the  evidence  for 
assuming  a  causal  connection  is  of  the  slightest.  That 
convenient  refuge  from  etiological  uncertainty,  "ptomain 
poisoning,"  is  a  diagnosis  that  unquestionably  has  been 
made  to  cover  a  great  variety  of  diverse  conditions, 
from  appendicitis  and  the  pain  caused  by  gallstones 
to  the  simple  abdominal  distention  resulting  from  reck- 
less gorging. 

No  doubt  can  be  entertained,  however,  that  intes- 
tinal and  other  disorders  due  to  particular  articles  of 
food  occur  much  more  frequently  than  they  are  recorded. 
There  are  few  persons  who  have  not  experienced  gastro- 
intestinal attacks  of  moderate  severity  which  could 
be  reasonably  attributed  to  something  eaten  shortly 
before.  It  is  often  possible  to  specify  with  a  fair  degree 
of  certainty  the  offending  food.  The  great  majority 
of  such  attacks  are  of  a  mild  character,  are  quickly 
recovered  from,  and  are  never  heard  of  beyond  the 
immediate  family  circle.  Only  when  the  attack  is 
more  serious  than  the  average  or  when  a  large  number 
of  persons  are  affected  simultaneously  does  knowledge 
of    the    occurrence    become    more    widely    spread.     A 


2  FOO])  POISONING 

small  proportion-  of  ^ood-poisoning  cases  receives 
notice  in  the  public  press  and  a  still  smaller  propor- 
tion is  reported  in  the  medical  journals.  Very  few 
indeed  are  ever  completely  investigated  as  to  their 
origin. 

Although  most  attacks  of  food  poisoning  are  usually 
of  a  slight  and  apparently  temporary  nature,  it  does 
not  follow  that  they  are  to  be  considered  .negligible  or 
of  trivial  importance  from  the  standpoint  of  public 
health.  The  human  organism  is  always  more  or  less 
weakened  by  such  attacks,  many  of  them,  as  we  shall 
see,  genuine  infections;  and,  as  is  known  to  be  the  case 
with  many  infectious  diseases,  some  permanent  injurious 
impression  may  be  left  on  the  body  of  the  affected 
individual.  Under  certain  conditions  it  is  possible  that 
degenerative  changes  are  initiated  or  accelerated  in  the 
kidneys  or  blood  vessels  by  the  acute  poisoning  which 
is  manifested  for  a  short  time  in  even  the  milder  cases. 
In  yet  greater  degree  these  changes  may  follow  those 
insidious  forms  of  food  poisoning  due  to  the  frequent 
ingestion  of  small  quantities  of  mineral  or  organic 
poisons,  which  in  each  dose  may  cause  little  or  no  measur- 
able physiological  change,  but  whose  cumulative  effect 
may  be  vicious.  In  view  of  the  grave  situation  evi- 
denced by  the  increase  in  the  degenerative  diseases 
affecting  early  middle  life  in  the  United  States,^  the 
extent,  causes,  and  means  of  prevention  of  food  poison- 
ing seem  pressing  subjects  for  investigation. 

'  Tables  A  and  B  show  that  the  "expectation  of  life"  for  adults  of 
forty  years  and  over  is  shorter  in  New  York  City  now  than  it  was  thirty 
years  ago  (Table  A),  and  that  this  increase  in  the  death-rate  in  the  higher- 
age  groups  is  manifested  in  recent  years  in  a  wide  area  in  this  country 


INTRODUCTION  3 

THE  EXTENT  OF  FOOD  POISONING 

Since  cases  of  food  poisoning,  "ptomain  poisoning," 
and  the  like  are  not  required  by  law  to  be  reported, 
public  health  authorities  in  general  possess  no  informa- 
tion respecting  their  occurrence.  Very  indirect  and 
imperfect  indications  of  the  prevalence  of  certain  kinds 
of  food  poisoning  are  afforded  by  casual  press  reports. 
Such  as  they  are,  these  accounts  are  the  only  available 
material.  Tables  I  and  II  summarize  data  I  have  gath- 
ered through  a  press-clipping  bureau  and  other  sources 
durmg   the  period    October,    19 13,    to   October,    191 5. 


(Table  B).    This  increased  mortality  is  due  chiefly  to  diseases  of  the 
heart,  arteries,  and  kidnej's,  and  to  cancer. 


TABLE  A* 

Approximate  Life  Table,  Trienna  1870-81  and  1909-11,  Based  on 
New  York  City  Statistics 


Ages 

Expectation  of  Life, 
1879-81 

Expectation  of  Life, 
1909-11 

Gain  (+)  or 

Loss  (— )  in  Years 

of  Expectancy 

41 -3 

46.3 

43-8 

39-7 

35.8 

32.6 

29.6 

26,7 

23.0 

21 .1 

18.3 

lS-4 

130 

lO-S 

8.9 

7.3 

6.4 

SS 

51-9 

Sii 

46.9 

42. s 

38.3 

34-3 

30.5 

26.9 

23-4 

20.0 

16. 8 

139 

11-3 

9.1 

7.2 

5-S 

4-3 

2.2 

+10.6 

+  4.8 
+  3.1 

-I-  2.8 

+    2.S 

+   0.9 

+    0.2 

-  o.s 

-  IS 

-  1-7 

60 .    . 

6s 

—  1.8 

80:::::::::::::: 

85 

+26.6 

-16.6 

+10.0 

*  Monlhly  Bull.,  Dept.  of  Health,  City  of  New  York,  III  (1913),  113. 
(Footnote  continued  ou  p.  4) 


FOOD  POISONING 


They  serve  to  show  at  least  the  universality  and  com- 
plexity of  the  problem. 

The  375  group  and  family  outbreaks  together 
involved  5,238  persons.  While  it  is  not  probable  that 
all  the  instances  reported  as  due  to  food  poisoning  can 
properly  be  so  considered,  there  is  no  doubt  that  the 
number  recorded  in  the  tables  falls  far  short  of  the 
actual  occurrences.  In  the  past  few  years  the  writer 
has  investigated  several  large  food-poisoning  outbreaks 
which  have  never  been  reported  in  the  press  nor  received 
public  notice  in  any  way.  There  is  reason  to  think  that 
the  majority  of  cases  escape  notice.  Probably  several 
thousand  outbreaks  of  food  poisoning  in  families  and 
larger  groups,  afifecting  at  least  15,000-20,000  persons, 
occur  in  the  United  States  in  the  course  of  a  year. 

The  assignment  of  causes  indicated  in  Table  I  is 
of  limited  value.  The  tendency  to  incriminate  canned 
food  is  here  manifest.  Proper  investigation  of  the  origin 
of  an  outbreak  is  so  rarely  carried  out  that  the  articles 


TABLE  B* 

Comparison  of  Mortality  of  Males  and  Females,  by  Age  Groups.    Death-Rates 
PER  1,000  Population    (Registration  States  as  Constituted  in  1900) 


Ages 

Males 

Percentage 

Increase  or 

Decrease 

Females 

Percentage 

Increase  or 

Decrease 

1900 

1911 

1900 

1911 

Under     5     

5-9 

10-14 

15-19 

20-24 

25-34 

35-44 

45-54 

55-64 

65-74 

75  and  over 
All  ages .... 

54-2 

4.7 

2.9 

4-9 

7.0 

8.3 

10.8 

15.8 

28.9 

59-6 

146. 1 

17.6 

39 

3 

2 

3 

5 

6 

10 

16 

30 

61 

147 

IS 

8 

4 
4 
7 
3 
7 
4 
I 
9 
6 
4 
8 

—  26.27 

—  27.66 
-17.24 
-24.49 
-24.29 
-19.28 

—  3.70 
-1-  1.90 
+  6.92 
+  3.36 
+     .89 
—10.23 

45 

4 

3 

4 

6 

8 

9 

14 

25 

53 

139 

16 

8 
6 

I 
8 
7 
2 
8 
2 
8 
8 
5 
5 

33-3 

31 

2.1 

3-3 

4.7 

6.0 

8.3 

12.9 

26.8 

55-1 

139.2 

14.0 

-27.29 
—32.61 
-32.26 
-31.25 
-29.85 
-26.83 
-15.31 
-  9.15 
+  0.78 
-1-2.42 
-|-  0.22 
-15.15 

*  Dublin,  Amcr.  Jour.  Public  Health,  III  (1913),  1262. 


INTRODUCTION 


of  food  ordinarily  accused  arc  selected  rather  as  the 
result  of  popular  prejudice  and  tradition  than  of  any 
careful  inquiry. 

TABLE  I 

Food  Poisoning  in  the  United  States,  October,  1913, 
TO  October,  191 5 


Assigned  cause 


Group 
and  Family 
Outbreaks 


Individual 
Cases 


Total 


Meat 

Canned  fish 

Canned  vegetables 

Ice  cream 

Fish,  oysters 

Cheese 

Sausage  and  canned  meat 

Milk 

Mushrooms 

Fruit 

Vegetables 

Fowl 

Salad 

Contact  of  food  or  drink  with  metal 
Miscellaneous 

No  cause  assigned 


40 
29 
27 
31 
17 
31 
18 

14 
12 
8 
II 
12 

9 
12 
29 


35 
35 
34 
22 

31 

9 

18 

13 

7 

II 

7 
4 
5 

I 

55 


75 
64 
61 

53 
48 
40 
36 
27 
19 
19 
18 
16 
14 
13 
84 


300 

357 


287 


587 
445 


657 


375 


1,032 


TABLE  II 

Seasonal  Distribution  of  Food  Poisoning  Cases,  1914-15 
(Group,  Family,  and  Individual) 


January . 
February 
March . . . 
April 


90 
66 
75 
79 


May.. 
June. .  , 
July... 
August 


63 
108 

99 
96 


September . 
October.  .  . 
November . 
December. 


76 
96 
96 
88 


There  is  no  very  striking  seasonal  incidence  apparent 
in  the  figures  here  gathered  (Table  II).     The  warmer 


6  FOOD  POISONING 

months  seem  to  have  a  slight  preponderance  of  cases, 
but  general  conclusions  from  such  data  are  hardly 
warranted. 

VARIOUS   KINDS    OF   FOOD   POISONING 

Cases  of  poisoning  by  articles  of  food  may  be  dis- 
tinguished as:  (i)  those  caused  by  some  injurious 
constituent  in  the  food  itself,  and  (2)  those  caused  by  a 
peculiar  condition  of  the  individual  consuming  the 
food,  by  virtue  of  which  essentially  wholesome  food 
substances  are  capable  of  producing  physiological  dis- 
turbance in  certain  individuals.  The  latter  group 
includes  persons,  apparently  normal  in  other  respects, 
who  are  more  or  less  injuriously  affected  by  some  partic- 
ular article  of  diet,  such  as  eggs  or  milk,  which  is  eaten 
with  impunity  by  all  normal  individuals.  This  is  the 
so-called  food  sensitization  or  food  allergy. 

Food  poisoning,  as  more  commonly  understood,  is 
due  to  the  composition,  contents,  or  contamination  of 
the  food  itself.  It  is  not  within  the  scope  of  this  book 
to  consider  any  of  those  cases  in  which  definite  poisonous 
substances  are  added  to  food  with  criminal  intent. 
The  term  food  poisoning  is  here  taken  to  include  the 
occasional  cases  of  poisoning  from  organic  poisons 
present  in  normal  animal  or  plant  tissues,  the  more  or 
less  injurious  consequences  following  the  consumption 
of  food  into  which  formed  mineral  or  organic  poisons 
have  been  introduced  by  accident  or  with  intent  to 
improve  appearances  or  keeping  quality,  the  cases  of 
infection  due  to  the  swallowing  of  bacteria  and  other 
parasites  which  infest  or  contaminate  certain  foods, 
and  the  poisoning  due  to  deleterious  substances  pror 


INTRODUCTION  7 

duced  in  food  by  the  growth  of  bacteria,  molds,  and 
similar  organisms.  As  already  pointed  out,  little  is 
known  about  the  relative  frequency  of  occurrence  of 
these  different  causes  or  the  extent  to  which  they  are 
separately  and  collectively  operative. 

THE   ARTICLES    OF   FOOD    MOST   COMMONLY   CONNECTED 
WITH   FOOD   POISONING 

In  addition  to  the  definitely  poisonous  plants  or 
animals,  certain  everyday  articles  of  food  have  been 
frequently  associated  with  the  more  serious  outbreaks 
of  food  poisoning.  Meat  in  particular  has  been  impli- 
cated so  often  that  the  term  meat  poisoning  is  used 
about  as  commonly  as  the  term  food  poisoning  in  general 
discussions  of  this  subject.  Certain  it  is  that  the  great 
majority  of  the  best-studied  and  most  severe  outbreaks 
of  food  poisoning  have  been  attributed  on  good  grounds 
to  the  use  of  meat  or  meat  products.  Other  animal 
foods,  and  especially  milk  and  its  derivatives,  cheese 
and  ice-cream,  have  likewise  been  held  responsible  for 
extensive  and  notable  outbreaks. 

Perhaps  the  most  significant  feature  of  food  poisoning 
attacks  is  the  frequency  with  which  they  have  been 
traced  to  the  use  of  raw  or  imperfectly  cooked  food. 
The  probable  interpretation  of  this  fact  will  be  discussed 
in  the  later  chapters.  Especially  have  the  use  of  un- 
cooked milk,  either  by  itself  or  mixed  with  other  food 
substances,  and  the  eating  of  raw  sausage  brought  in 
their  train  symptoms  of  poisoning  in  a  disproportionately 
large  number  of  cases. 

Canned  goods  of  various  sorts  have  likewise  been 
repeatedly  accused  of  causing  injurious  effects,  but  the 


8  FOOD  POISONING 

evidence  adduced  is  not  always  convincing.  The 
actual  degree  of  danger  from  this  source  is  far  from 
being  determined.  The  National  Canners  Association 
pubhshes  in  the  annual  report  of  the  secretary  a  brief  list 
of  "libels  on  the  industry"  or  instances  in  which  canned 
foods  of  various  sorts  were  regarded  as  the  cause  of 
illness.  The  1916  report  contains  fifty -one  cases  of 
this  character,  none  of  which  was  considered  by  the 
investigator  of  the  Association  to  be  based  on  sound 
evidence.  A  still  more  searching  investigation  of  all 
such  cases  would  seem  to  be  desirable,  not  with  a  view 
to  incriminating  or  exculpating  any  particular  product, 
but  simply  for  the  purpose  of  ascertaining  and  placing 
on  record  all  the  facts. 


CHAPTER  II 
SENSITIZATION  TO  PROTEIN  FOODS 

The  first  introduction  under  the  skin  of  a  guinea-pig 
of  a  minute  quantity  of  egg-white  or  other  apparently 
harmless  protein  substance  is  itself  without  visible 
injurious  effect,  but  if  this  is  followed  by  a  second 
injection  of  the  same  substance  after  an  interval  of 
about  ten  days,  the  animal  will  die  in  a  few  minutes 
with  symptoms  of  violent  poisoning.  Whatever  be 
the  physiological  explanation  of  the  remarkable  change 
that  thus  results  from  the  incorporation  of  foreign 
protein  into  the  body,  there  can  be  no  doubt  that  the 
phenomenon  known  as  protein  sensitization  or  anaphy- 
laxis is  relatively  common.^  Sensitization  to  proteins 
came  to  light  in  the  first  instance  through  the  study  of 
therapeutic  sera,  and  has  been  found  to  have  unexpect- 
edly wide  bearings.  It  is  now  known  that  not  only 
the  rash  and  other  symptoms  which  sometimes  follow 
the  administration  of  horse  serum  containing  diphtheria 
antitoxin,  but  the  reaction  to  tuberculin  and  similar 
accompaniments  of  bacterial  infection,  are  probably 
to  be  explained  on  the  principle  of  anaphylactic  change. 
The  sensitiveness  of  certain  individuals  to  the  pollen 
of  particular  plants  (hay  fever)  is  also  regarded  as  a 

'  General  agreement  respecting  the  true  physiological  and  chemical 
nature  of  anaphylactic  phenomena  has  not  yet  been  reached.  For 
a  discussion  of  the  theories  of  anaphylaxis,  see  in  Hans  Zinsser,  Infection 
and  Resistance  (New  York,  1914),  chaps,  xv-xviii;  also  Doerr, 
"Allergie  and  Anaphylaxis,"  in  Kolle  and  Wassermann,  Ilandbuch,  2d 
edition,  1913,  II,  947. 


lO  FOOD  POISONING 

typical  instance  of  anaphylaxis,  accompanied  as  it 
is  by  asthma  and  other  characteristic  manifestations 
of  the  anaphylactic  condition. 

Among  the  reactions  usually  classed  as  anaphylactic 
are  the  occasional  cases  of  sensitivity  to  particular  food 
substances.  It  is  a  familiar  fact  that  certain  foods 
that  can  be  eaten  with  impunity  by  most  persons 
prove  more  or  less  acutely  poisonous  for  others.  Straw- 
berries and  some  other  fruits  and  some  kinds  of  shell- 
fish are  among  the  articles  of  food  more  commonly 
implicated.  Unpleasant  reactions  to  the  use  of  eggs 
and  of  cow's  milk  are  also  noted.  The  severity  of  the 
attacks  may  vary  from  a  slight  rash  to  violent  gastro- 
intestinal, circulatory,  and  nervous  disturbances. 

Coues'  has  described  a  rather  typical  case  in  a  child 
twenty-one  months  old  and  apparently  healthy  except 
for  some  eczema.  When  the  child  was  slightly  over 
a  year  old  egg-white  was  given  to  it,  and  nausea  and 
vomiting  immediately  followed.  About  eight  months 
later  another  feeding  with  egg-white  was  followed  by 
sneezing  and  all  the  symptoms  of  an  acute  coryza. 
Extensive  urticaria  covering  most  of  the  body  also 
appeared,  and  the  eyelids  became  edematous.  The 
temperature  remained  normal  and  there  was  no  marked 
prostration.  The  symptoms  of  such  attacks  vary 
considerably  in  difTerent  individuals,  but  usually  include 
pronounced  urticaria  along  with  nausea,  vomiting,  and 
diarrhea.  The  rapidity  with  which  the  symptoms 
appear  after  eating  is  highly  characteristic.  Schloss^ 
has  reported  a  case  of  an  eight-year-old  boy  who  evinced 

'  Boston  Med.  and  Surg.  .Tour.,  CLXVII  (1912),  216. 
^  Atner.  Jour.  Obslet.  (New  York),  LXV  (1912),  731. 


SENSITIZATION  TO  PROTEIN  FOODS  ii 

marked  sensitiveness  to  eggs,  almonds,  and  oatmeal. 
Experiments  in  this  instance  showed  that  a  reaction 
was  produced  only  by  the  proteins  of  these  several 
foods,  and  that  extracts  and  preparations  free  from 
protein  were  entirely  inert.  It  was  further  found  that 
by  injection  of  the  patient's  blood  serum  guinea-pigs 
could  be  passively  sensitized  against  the  substances  in 
question,  thus  showing  the  condition  to  be  one  of  real 
anaphylaxis. 

Idiosyncrasy  to  cow's  milk  which  is  observed  some- 
times in  infants  is  an  anaphylactic  phenomenon.'  The 
substitution  of  goat's  milk  for  cow's  milk  has  been 
followed  by  favorable  results  in  such  cases. 

In  very  troublesome  cases  of  protein  idiosyncrasy  a 
method  of  treatment  based  on  animal  experimentation 
has  been  advocated.  This  consists  in  the  production 
of  a  condition  of  "anti-anaphylaxis''  by  systematic 
feeding  of  minute  doses  of  the  specific  protein  substance 
concerned.^  S.  R.  Miller''  describes  the  case  of  a  child 
in  whom  a  constitutional  reaction  followed  the  adminis- 
tration of  one  teaspoonful  of  a  mixture  composed  of  one 
pint  of  water  plus  one  drop  of  egg-white,  while  a  like 
amount  of  albumen  diluted  with  one  quart  of  water 
was  tolerated  perfectly.  "Commencing  with  the  dilu- 
tion which  failed  to  produce  a  reaction,  the  child  was 
given  gradually  increasing  amounts  of  solutions  of 
increasing  strength.  The  dosage  was  always  one 
teaspoonful  given  three  times  during  the  day;  the 
result  has  been  that,  in  a  period  of  about  three  months, 

'  F.  B.  Talbot,  Boston  Med.  and  Surg.  Jour.,  CLXXV  (1916),  409. 
^  See,  for  example,  Schloss,  loc.  cit.  ^ 

^  Johns  Hopkins  Hasp.  Bull.,  XXV  (1914),  78. 


12  FOOD  POISONING 

the  child  has  been  desensitized  to  such  an  extent  that 
one  dram  of  pure  egg-white  is  now  taken  with  impunity." 

Many  other  instances  of  anaphylaxis  to  egg  albu- 
men are  on  record.'  In  some  of  these  cases  the  amount 
of  the  specific  protein  that  suffices  to  produce  the 
reaction  is  exceedingly  small.  One  physician  writes 
of  a  patient  who  ''was  unable  to  take  the  smallest 
amount  of  egg  in  any  form.  If  a  spoon  was  used  to 
beat  eggs  and  then  to  stir  his  coft'ee,  he  became  very 
much  nauseated  and  vomited  violently."^ 

The  dependence  of  many  cases  of  ''asthma"  upon 
particular  foods  is  an  established  fact.  Various  skin 
rashes  and  eruptions  are  likewise  associated  with  sensiti- 
zation to  certain  foods.^  McBride  and  Schorer'^  consider 
that  each  particular  kind  of  food  (as  tomatoes  or  cereals) 
produces  a  constant  and  characteristic  set  of  symptoms. 
Possibly  certain  definitely  characterized  skin  diseases 
are  due  to  this  form  of  food  poisoning.  Blackfan^ 
found  that  of  forty-three  patients  without  eczema  only 
one  showed  any  evidence  of  susceptibility  to  protein  by 
cutaneous  and  intracutaneous  tests,  while  of  twenty- 
seven  patients  with  eczema  twenty-two  gave  evidence 
of  susceptibility  to  proteins. 

'  See,  for  example,  K.  Koessler,  ///.  Med.  Jour.,  XXIII  (1913),  66; 
Bronfenbrenner,  Andrews,  and  Scott,  Jour.  Anier.  Med.  Assoc,  LXIV 
(1915),  1306;  F.  B.  Talbot,  Boston  Med.  and  Surg.  Jour.,  CLXXI 
(1914),  708. 

'^  Jour.  Amer.  Med.  Assoc,  LXV  (1915),  1837. 

3  Strickler  and  Goldberg,  Jour.  Amer.  Med.  Assoc,  LXVI  (1916),  249. 

^  Jour.  Cutaneous  Dis.,  XXXIV  (1916),  70. 

s  Amer.  Jour.  Dis.  of  Children,  XI  (1916),  441. 


CHAPTER  III 
POISONOUS  PLANTS  AND  ANIMALS 

Some  normal  plant  and  animal  tissues  contain 
substances  poisonous  to  man  and  are  occasionally  eaten 
by  mistake  for  wholesome  foods. 

POISONOUS   PLANTS 

Poisonous  plants  have  sometimes  figured  con- 
spicuously in  human  affairs.  Every  reader  of  ancient 
history  knows  how  Socrates  "drank  the  hemlock,"' 
and  how  crafty  imperial  murderers  were  likely  to 
substitute  poisonous  mushrooms  for  edible  ones  in  the 
dishes  prepared  for  guests  who  were  out  of  favor.  In 
our  own  times  the  eating  of  poisonous  plants  is  generally 
an  accident,  and  poisoning  from  this  cause  occurs 
chiefly  among  the  young  and  the  ignorant. 

According  to  Chesnut^  there  are  16,673  leaf-bearing 
plants  included  in  Heller's  Catalogue  of  North  American 
Plants,  and  of  these  nearly  five  hundred,  m  one  way 
or  another,  have  been  alleged  to  be  poisonous.  Some 
of  these  are  relatively  rare  or  for  other  reasons  are  not 
likely  to  be  eaten  by  man  or  beast;  others  contain  a 
poison  only  in  some  particular  part,  or  are  poisonous 
only  at  certain  seasons  of  the  year;  in  some  the  poison 
is  not  dangerous  when  taken  by  the  mouth,  but  only 
when  brought  in  contact  with  the  skin  or  injected 
beneath  the  skin  or  into  the  circulation.  There  are 
great  difterences  in  individual  susceptibility  to  some 

'  Science,  XV  (1902),  loxO. 

13 


14  FOOD  POISONING 

of  these  plant  poisons.  One  familiar  plant,  the  so- 
called  poison-ivy,  is  not  harmful  for  many  people  even 
when  handled  recklessly;  it  can  be  eaten  with  impunity 
by  most  domestic  animals. 

The  actual  number  of  poisonous  plants  likely  to  be 
inadvertently  eaten  by  human  beings  is  not  large. 
Chesnut'  has  enumerated  about  thirty  important 
poisonous  plants  occurring  in  the  United  States,  and 
some  of  these  are  not  known  to  be  poisonous  except 
for  domestic  animals.^  Many  of  the  cases  of  reported 
poisoning  in  man  belong  to  the  class  of  exceedingly  rare 
accidents  and  are  without  much  significance  in  the 
present  discussion.  Such  are  the  use  of  the  leaves  of  the 
American  false  hellebore  {Veratrum  viride)  in  mistake 
for  those  of  the  marsh-marigold'',  the  use  of  the  fruit 
pulp  of  the  Kentucky  coffee  tree  (Gymnocladus  dioica) 
in  mistake  for  that  of  the  honey-locust'',  the  accidental 
employment  of  daffodil  bulbs  for  food,  and  the  confusion 
by  children  of  the  young  shoots  of  the  broad-leaf  laurel 
{Kalmia  latifoUa)  with  the  wintergreen.s     One  of  the 

•  U.S.  Depl.  of  Agric,  Div.  of  Botany,  Bull.  20,  1898. 

^  Among  the  plants  that  seem  to  be  most  commonly  implicated  in 
the  poisoning  of  stock  are  the  larkspur  {Delphinium.  U.S.  Dcpt.  of 
Agric,  Bull.  j6j,  September  8,  1916),  the  water  hemlock  (Cicula  macu- 
lata)  and  others  of  the  same  genus,  the  lupines  {U.S.  Dcpt.  of  Agric, 
Bull.  405,  i9i6),some  of  the  laurels  {Kalmia),  and  the  Death  Camas  or 
Zygadenus  {U.S.  Depl.  of  Agric,  Bull.  125,  19 15).  The  famous  loco- 
weed  of  the  western  United  States  {U.S.  Dept.  of  Agric,  Bull.  112,  1909) 
is  less  certainly  to  be  held  responsible  for  all  the  ills  ascribed  to  it  (H.  T. 
Marshall,  Johus  Hopkins  Hosp.  Bull.,  XXV  [1914],  234). 

*  Chesnut,  U.S.  Depl.  of  Agric,  Div.  of  Botany,  Bull.  20,  1898,  p.  17. 

"/WtJ-.p.  28. 

s  Ibid.,  p.  45.  The  seeds  of  the  castor-oil  bean,  which  contain  a 
very  powerful  poison  (ricin)  allied  to  the  bacterial  toxins,  have  been 
known  to  cause  the  death  of  children  who  ate  the  seeds  given  them  to 
play  with. 


rOISONOUS  PLANTS  AND  ANIMALS 


15 


<:.■     T 


Fig.  I. — Conium  maculatiim.  The  fresh  juice  of  Coniiim  maciilalum 
was  used  in  the  preparation  of  the  famous  hemlock  potion  which  was 
employed  by  the  Greeks  in  putting  their  criminals  to  death.  (From 
Applied  and  Economic  Botany,  by  courtesy  of  Professor  Kraemer  [after 
Holm].) 


1 6  FOOD  rOISONING 

most  serious  instances  of  poisoning  of  this  sort  is  that 
from  the  use  of  the  spindle-shaped  roots  of  the  deadly 
water  hemlock  {Cicuta  maculata)  allied  to  the  more 
famous  but  no  more  deadly  poison  hemlock.  These 
underground  portions  of  the  plant  are  sometimes 
exposed  to  view  by  washing  out  or  freezing,  and 
are  mistaken  by  children  for  horseradish,  artichokes, 
parsnips,  and  other  edible  roots.  Poisoning  with  water 
hemlock  undoubtedly  occurs  more  frequently  than 
shown  by  any  record.  Eight  cases  and  two  deaths 
from  this  cause  are  known  to  have  occurred  in  one  year 
in  the  state  of  New  Jersey  alone. 

An  instance  of  food  poisoning  to  be  included  under 
this  head  is  the  outbreak  in  Hamburg  and  some  thirty 
other  German  cities  in  191 1  due  to  the  use  of  a  poisonous 
vegetable  fat  in  preparing  a  commercial  butter  sub- 
stitute.' In  the  attempt  to  cheapen  as  far  as  possible 
the  preparation  of  margarin  various  plant  oils  have 
been  added  by  the  manufacturers.  In  the  Hamburg 
outbreak,  in  which  over  two  hundred  cases  of  illness 
occurred,  poisoning  was  apparently  due  to  substitution 
of  so-called  maratti-oil,  derived  from  a  tropical  plant 
(Hydrocarpus).  This  fat  is  said  to  be  identical  with  oil 
of  cardamom,  and  its  toxic  character  in  the  amounts 
used  in  the  margarin  was  proved  by  animal  experiment. 
Increasing  economic  pressure  for  cheap  foods  may  lead 
to  the  recurrence  of  such  accidents  unless  proper  pre- 
cautions are  used  in  testing  out  new  fats  and  other 
untried  substances  intended  for  use  in  the  preparation 
of  food  substances.^ 

'Mayer,  Deutsche  Viertclj.f.  djfetitl.  Ges.,  XLV  {1913),  12. 

^  Cf.  an  instance  of  palmolin  poisoning,  Ceniralbl.f.  BakL,  I,  Ref., 
LXII  (1914),  210. 


POISONOUS  PLANTS  AND  ANIMALS 


17 


Investigators    from    the    New    York    City    Health 
Department  have  found   that  certain  cases  of  alleged 


Fig.  2. — Ciciitd  maculala  (water  hemlock):  A,  upper  part  of  stem 
with  leaves  and  compound  umbels;  B,  base  of  stem  and  thick  tuberous 
roots;  C,  cross-section  of  stem;  D,  flower;  E,  fruit;  F,  fruit  in  longitu- 
dinal section;  G,  cross-section  of  a  mericarp.  (From  Applied  and 
Economic  Botany,  by  courtesy  of  Professor  Kraemer  [after  Holm].) 


1 8  FOOD  POISONING 

''ptomain  poisoning"  were  really  due  to  ''sour-grass 
soup."'  This  soup  is  prepared  from  the  leaves  of  a 
species  of  sorrel  rich  in  oxalic  acid.  In  one  restaurant 
it  was  found  that  the  soup  contained  as  much  as  ten 
grains  of  oxalic  acid  per  pint! 

By  far  the  best-known  example  of  that  form  of 
poisoning  which  results  from  confounding  poisonous 
with  edible  foods  is  that  due  to  poisonous  mushrooms.^ 
There  is  reason  to  believe  that  mushroom  (or  "toad- 
stool") intoxication  in  the  United  States  has  occurred 
with  greater  frequency  of  late  years,  partly  on  account 
of  the  generally  increasing  use  of  mushrooms  as  food 
and  the  consequently  greater  liability  to.  mistake,  and 
partly  on  account  of  the  growth  of  immigration  from 
the  mushroom-eating  communities  of  Southern  Europe. 
Many  instances  have  come  to  light  in  which  immigrants 
have  mistaken  poisonous  varieties  in  this  country  for 
edible  ones  with  which  they  were  familiar  at  home. 
In  the  vicinity  of  New  York  City  there  were  twenty-two 
deaths  from  mushroom  poisoning  in  one  ten-day  period 
(September,  191 1)  following  heavy  rains.  The  "fly 
Amanita"^  {Amanita  muscaria)  in  this  country  has  been 
apparently  often  mistaken  for  the  European  variety 
of    "royal  Amanita'''    {A.   caesaria).'^     Such  a  mistake 

'  Weekly  Bull,  N.Y.  Dept.  of  Health,  September  16,  1916. 

^  Seventy-three  species  of  mushrooms  known  or  suspected  to  be 
poisonous  are  enumerated  in  a  bulletin  of  the  United  States  Department 
of  Agriculture,  Patterson  and  Charles  ("Mushrooms  and  Other  Common 
Fungi,"  Bull.  175,  1915)-  This  bulletin  contains  descriptions  and 
excellent  illustrations  of  many  edible  and  of  the  commoner  poisonous 
species. 

3  Used  in  some  places  as  a  fly  poison. 

*  Ford,  Science,  XXX  (1909),  97. 


POISONOUS  PLANTS  AND  ANIMALS 


19 


(^ 


2  5 

i  s 


20  FOOD  POISONING 

seems  to  have  been  the  cause  of  death  of  the  Count 
de  Vecchi  in  Washington,  D.C.,  in  1897. 

The  Count,  an  attache  of  the  Italian  legation,  a  cultivated 
gentleman  of  nearly  sixty  years  of  age,  considered  something 
of  an  expert  upon  mycology,  purchased,  near  one  of  the  markets 
in  Washington,  a  quantity  of  fungi  recognized  by  him  as  an  edible 
mushroom.  The  plants  were  collected  in  V^irginia  about  seven 
miles  from  the  city  of  Washington.  The  following  Sunday 
morning  the  count  and  his  physician,  a  warm  personal  friend, 
breakfasted  together  upon  these  mushrooms,  commenting  upon 
their  agreeable  and  even  delicious  flavor.  Breakfast  was  con- 
cluded at  half  after  eight  and  within  fifteen  minutes  the  count  felt 
symptoms  of  serious  illness.  So  rapid  was  the  onset  that  by 
nine  o'clock  he  was  found  prostrate  on  his  bed,  oppressed  by  the 
sense  of  impending  doom.  He  rapidly  developed  blindness, 
trismus,  difficulty  in  swallowing,  and  shortly  lost  consciousness. 
Terrific  convulsions  then  supervened,  so  violent  in  character 
as  to  break  the  bed  upon  which  he  was  placed.  Despite  rigorous 
treatment  and  the  administration  of  morphine  and  atropine,  the 
count  never  recovered  consciousness  and  died  on  the  day  following 
the  accident.  The  count's  physician  on  returning  to  his  office 
was  also  attacked,  dizziness  and  ocular  symptoms  warning  him 
of  the  nature  of  the  trouble.  Energetic  treatment  with  apo- 
morphine  and  atropine  was  at  once  instituted  by  his  colleagues 
and  for  a  period  of  five  hours  he  lay  in  a  state  of  coma  with  occa- 
sional periods  of  lucidity.  The  grave  symptoms  were  ameliorated 
and  recovery  set  in  somewhere  near  seven  o'clock  in  the  evening. 
His  convalescence  was  uneventful,  his  restoration  to  health  com- 
plete, and  he  is,  I  believe,  still  living.  In  this  instance  the  count 
probably  identified  the  fungi  as  caesaria  or  aurantiaca.  From 
the  symptoms  and  termination  the  species  eaten  must  have  been 
mMscaria. 

A.  muscaria  contains  an  alkaloidal  substance  which 
has  a  characteristic  effect  upon  the  nerve  centers  and  to 
which  the  name  muscarin  and  the  provisional  chemical 
formula  C5H15NO3  has  been  given.     The  drug  atropin 


POISONOUS  PLANTS  AND  ANIMALS  21 

is  a  more  or  less  perfect  physiological  antidote  for 
muscarin  and  has  been  administered  with  success  in 
cases  of  muscarin  poisoning.  It  is  said  that  the  peasants 
in  the  Caucasus  are  in  the  habit  of  preparing  from  the 
fly  Amanita  a  beverage  which  they  use  for  producing 
orgies  of  intoxication.  Deaths  are  stated  to  occur  fre- 
quently from  excessive  use  of  this  beverage.' 

The  deadly  Amamta  or  death-cup  (A.  phalloides) 
is  probably  responsible  for  the  majority  of  cases  of 
mushroom  poisoning.  P'ord  estimates  that  from  twelve 
to  fifteen  deaths  occur  annually  in  this  country  from 
this  species  alone.  This  fungus  is  usually  eaten  through 
sheer  ignorance  by  persons  who  have  gathered  and 
eaten  whatever  they  chanced  to  find  in  the  woods.  A 
few  of  these  poisonous  mushrooms  mixed  with  edible 
varieties  may  be  sufficient  to  cause  the  death  of  a  family. 
Ford  thus  describes  the  symptoms  of  poisoning  with 
A .  phalloides: 

Following  the  consumption  of  the  fungi  there  is  a  period  of 
six  to  fifteen  hours  during  which  no  symptoms  of  poisoning  are 
shown  by  the  victims.  This  corresponds  to  the  period  of  incu- 
bation of  other  intoxications  or  infections.  The  first  sign  of 
trouble  is  sudden  pain  of  the  greatest  intensity  localized  in  the 
abdomen,  accompanied  by  vomiting,  thirst,  and  choleraic  diar- 
rhoea with  mucous  and  bloody  stools.  The  latter  symptom  is 
by  no  means  constant.  The  pain  continues  in  paroxysms  often 
so  severe  as  to  cause  the  peculiar  Hippocratic  facies,  la  face 
vuUeuse  of  the  French,  and  though  sometimes  ameliorated  in 
character,  it  usually  recurs  with  greater  severity.  The  patients 
rapidly  lose   strength   and   flesh,   their   complexion  assuming   a 

'  Another  species  of  mushroom  occurring  in  this  country  and 
commonly  regarded  as  edible  {Paneolus  papiUonaceus)  has  on  occasion 
shown  marked  intoxicating  properties  (A.  E.  \'errill,  Science,  XL 
(1914),  40S). 


22  FOOD  POISONING 

peculiar  yellow  tone.  After  three  to  four  days  in  children  and 
six  to  eight  in  adults  the  victims  sink  into  a  profound  coma  from 
which  they  cannot  be  roused  and  death  soon  ends  the  fearful 
and  useless  tragedy.  Convulsions  rarely  if  ever  occur  and  when 
present  indicate,  I  am  inclined  to  believe,  a  mixed  intoxication, 
specimens  of  Amanita  muscaria  being  eaten  with  the  phalloidcs. 
The  majority  of  individuals  poisoned  by  the  "deadly  Amanita" 
die,  the  mortality  varying  from  60  to  100  per  cent  in  various 
accidents,  but  recovery  is  not  impossible  when  small  amounts 
of  the  fungus  are  eaten,  especially  if  the  stomach  be  very  promptly 
emptied,  either  naturally  or  artificially. 

A  number  of  other  closely  related  species  of  Amanita 
(e.g.,  A.  verna,  the  "destroying  angel,"  probably  a  small 
form  of  A.  phalloides)  have  a  poisonous  action  similar 
to  that  of  A .  phalloides.     All  are  different  from  muscarin. 

The  character  of  the  poison  was  first  carefully  investi- 
gated by  Kobert,  who  showed  that  the  Amanita  extract 
has  the  power  of  laking  or  dissolving  out  the  color- 
ing matter  from  red  blood  corpuscles.  This  hemolytic 
action  is  so  powerful  that  it  is  exerted  upon  the  red 
cells  of  ox  blood  even  in  a  dilution  of  i :  125,000.  Ford' 
has  since  shown  that  in  addition  to  the  hemolytic 
substance  another  substance  much  more  toxic  is  present 
in  this  species  of  Amanita  and  he  concludes  that  the 
poisonous  effect  of  the  fungus  is  primarily  due  to  the 
latter  ("Amanita  toxin").  The  juice  of  the  cooked 
Amanita  is  devoid  of  hemolytic  power,  but  is  poisonous 
for  animals  in  small  doses,  a  fact  that  agrees  with 
the  observation  that  these  mushrooms,  after  cooking, 
remain  intensely  poisonous  for  man.  Extensive  fatty 
degeneration  in  liver,  kidney,  and  heart  muscle  is 
produced  by  the  true  Amanita  toxin.     In  the  Baltimore 

'  Jour,  hijcct.  Dis.,  Ill  (1906),  ic;i. 


POISONOUS  PLANTS  AND  ANIMALS 


23 


Fig.  4. — Death-cup;  destroying  angel  {Amanita  plialloidcs  Fries); 
reduced;  natural  size:  cap,  32  inches;  stem,  7^  inches.  (After 
Marshall,  Tlic  Mushroom  Book,  by  courtesy  of  Doubleday,  Page  & 
Compan}'.) 


24  FOOD  POISONING 

cases  studied  by  Clark,  Marshall,  and  Rowntree'  the 
kidney  rather  than  the  liver  was  the  seat  of  the  most 
interesting  functional  changes.  These  authors  con- 
clude that  the  nervous  and  mental  symptoms,  instead 
of  being  due  to  some  peculiar  "neurotoxin,"  are  probably 
uremic  in  character.  No  successful  method  of  treatment 
is  known.  An  antibody  for  the  hemolysin  has  been 
produced,  but  an  antitoxin  for  the  other  poisonous 
substance  seems  to  be  formed  in  very  small  amount. 
Attempts  to  immunize  small  animals  with  Amanita 
toxin  succeed  only  to  a  limited  degree.' 

POISONOUS   ANIMALS 

While  the  muscles  or  internal  organs  of  many  animals 
are  not  palatable  on  account  of  unpleasant  flavor  or 
toughness,  there  do  not  seem  to  be  many  instances  in 
which  normal  animal  tissues  are  poisonous  when  eaten. 
As  pointed  out  elsewhere  (chapter  vi) ,  the  majority  of  out- 
breaks of  meat  and  fish  poisoning  must  be  attributed  to 
the  presence  of  pathogenic  bacteria  or  to  poisons  formed 
after  the  death  of  the  animal.  This  has  been  found 
especially  true  of  many  of  the  outbreaks  of  poisoning 
ascribed  to  oysters  and  other  shellfish;  in  most,  if  not 
all,  cases  the  inculpated  mollusks  have  been  derived 
from  water  polluted  with  human  wastes  and  are  either 
infected  or  partially  decomposed. 

In  some  animals,  however,  notably  certain  fish,  the 
living  and  healthy  organs  are  definitely  poisonous. 
The  family  of  Tetrodontidae  (puffers,  balloon-fish, 
globe-fish)    comprises   a   number  of  poisonous  species, 

^Jour.  Amer.  Med.  Assoc,  LXIV  (1915),  1230. 
*  W.  W.  Ford,  "Plant  Poisons  and  Their  Antibodies,"  Cenlralbl.  f. 
Bakt.,  I  Abt.,  Ref.,  LVIII  (1913),  129  and  193,  with  full  bibliography. 


POISONOUS  PLANTS  AND  ANIMALS  25 

including  the  famous  Japanese  Fugu,  which  has  many 
hundred  deaths  scored  against  it  and  has  been  often 
used  to  effect  suicide.  Poisonous  varieties  of  fish  seem 
more  abundant  in  tropical  waters  than  in  temperate, 
but  this  is  possibly  because  of  the  more  general  and 
indiscriminate  use  of  fish  as  food  in  such  localities  as 
the  Japanese  and  South  Sea  Islands.  It  is  known  that 
some  cool-water  fish  are  poisonous.  The  flesh  of  the 
Greenland  shark  possesses  poisonous  qualities  for  dogs 
and  produces  a  kind  of  intoxication  in  these  animals.' 

Much  uncertainty  exists  respecting  the  conditions 
under  which  the  various  forms  of  fish  poisoning  occur. 
One  type  is  believed  to  be  associated  with  the  spawning 
season,  and  to  be  caused  by  a  poison  present  in  the 
reproductive  tissues.  The  roe  of  the  European  barbel 
is  said  to  cause  frequent  poisoning,  not  usually  of  a 
serious  sort.  The  flesh  or  roe  of  the  sturgeon,  pike,  and 
other  fish  is  also  stated  to  be  poisonous  during  the 
spawning  season.  Some  fish  are  said  to  be  poisonous 
only  when  they  have  fed  on  certain  marine  plants.^ 

There  is  little  definite  knowledge  about  the  poisons 
concerned.  They  are  certainly  not  uniform  in  nature. 
The  Fiigu  poison  produces  cholera-like  s>Tnptoms,  con- 
vulsions, and  paralysis.  It  is  not  destroyed  by  boiling. 
The  effect  of  the  Greenland  shark  flesh  on  dogs  is 
described  as  being  "like  alcohol."  It  is  said  that  dogs 
fed  with  gradually  increasing  amounts  of  the  poisonous 
shark's  flesh  become  to  some  degree  immune.  Different 
symptoms  are  described  in  other  fish  poisoning  cases.-* 

'A.  H.  Clark,  Science,  XLI  (1915),  795. 

=>  See  W.  M.  Kerr,  U.S.  Nav.,  Monthly  Bull.,  VI  (191 2),  401. 

3  Ibid. 


CHAPTER  IV 
MINERAL  OR  ORGANIC  POISONS  ADDED  TO  FOOD 

Well-known  mineral  or  organic  poisons — "chemical 
poisons" — sometimes  find  their  way  into  food,  being 
either  introduced  accidentally  in  the  process  of  manu- 
facture or  preparation,  or  being  added  deliberately  with 
intent  to  improve  the  appearance  or  keeping  qualities 
of  the  food. 

ARSENIC 

So  powerful  a  poison  as  arsenic  has  been  occasionally 
introduced  into  food  by  stupidity  or  carelessness. 
Arsenic  has  been  found  by  English  authorities  to  be 
generally  present  in  food  materials  dried  or  roasted 
with  gases  arising  from  the  combustion  of  coal,  and  in 
materials  treated  with  sulphuric  acid  during  the  process 
of  preparation.  In  both  cases  the  source  is  the  same: 
the  iron  pyrites,  practically  always  arsenical,  con- 
tained in  the  coal  or  used  in  making  the  sulphuric 
acid. 

A  celebrated  epidemic  of  "peripheral  neuritis"  in 
the  English  Midlands  in  1900  was  traced  to  the  presence 
of  dangerous  quantities  of  arsenic  in  beer.  About 
six  thousand  persons  were  affected  in  this  outbreak  and 
there  were  some  seventy  deaths.  The  beer  coming 
from  the  suspected  breweries  had  all  been  manufactured 
with  the  use  of  brewing  sugars  obtained  from  a  single 
source,  and  these  sugars  were  found  to  have  been 
impregnated  with  arsenic  by  the  sulphuric  acid  used 

26 


MINERAL  POISONS  ADDED  TO  FOOD  27 

in  their  preparation,  some  specimens  of  the  acid  con- 
taining as  much  as  2 . 6  per  cent  of  arsenic' 

The  use  of  glucose,  not  only  in  beer,  but  as  an  admix- 
ture or  adulterant  in  jams,  syrups,  candies,  and  the 
like,  is  open  to  serious  objection  unless  the  glucose  is 
known  to  have  been  prepared  with  sulphuric  acid  freed 
from  arsenical  impurity.  In  fact,  the  use  of  any  food 
material  prepared  by  the  aid  of  sulphuric  acid  is  per- 
missible only  in  case  arsenic-free  acid  is  employed.^ 

ANTIMONY 

The  cheaper  grades  of  enameled  cooking  utensils 
in  use  in  this  country  contain  antimony,  and  this  is 
dissolved  out  in  noteworthy  amounts  in  cooking  various 
foods.^  The  rubber  nipples  used  for  infants'  milk 
bottles  also  sometimes  contain  antimony.''  Although 
the  poisonous  qualities  of  antimony  are  well  known, 
there  is  little  information  about  the  toxic  effect  of 
repeated  very  minute  doses.  Recognized  instances  of 
chronic  antimony  poisoning  are  very  rare.  Further  in- 
vestigation is  needed. 

LEAD 

The  well-known  poisonousness  of  lead  and  its 
compounds  prevents,  as  a  rule,  the  deliberate  addition 
of  lead  salts  to  food  substances,  although  it  is  true 

'  E.  S.  Reynolds,  Lancet,  I  (1901),  166. 

^  The  sulphuric  acid  used  in  making  glucose  in  the  United  States 
is  authoritatively  declared  to  be  absolutely  free  from  arsenic  (report  of 
hearing  before  Illinois  State  Food  Standard  Commission,  June  21-23, 
1916;  see  Amer.  Food  Jour.,  July,  1916,  p.  315). 

JE.  W.  Miller,  Jour.  Home  Economics,  VIII  (1916),  361. 

■•  Phelps  and  Stevenson,  Hyg.  Lab.,  U.S.  Public  Ileallh  Service, 
Bull.  q6,  1914,  p.  55. 


28  FOOD  POISONING 

that  lead  chromate  is  sometimes  used  for  imparting  a 
yellow  color  to  candy  and  decorating  sugars/  Foods 
that  are  wrapped  in  foil,  however,  such  as  chocolate 
and  soft  cheese,  contain  traces  of  lead,  as  do  the  contents 
of  preserve  jars  with  metallic  caps  and  the  "soft  drinks" 
vended  in  bottles  with  patent  metal  stoppers.  Occa- 
sional ingestion  of  minute  quantities  of  lead  is  probably 
a  matter  of  little  physiological  importance,  but  since 
lead  is  a  cumulative  poison,  frequent  taking  into  the 
body  of  even  very  small  amounts  entails  danger.  Severe 
lead  poisoning  has  been  known  to  result  from  the 
habitual  use  of  acid  beverages  contained  in  bottles  with 
lead  stoppers.  Investigations  made  to  determine  the 
possible  danger  of  poisoning  from  lead  taken  up  from 
glazed  and  earthenware  cooking  utensils  indicate  that 
injury  from  this  source  is  unlikely.  The  enameled  ware 
in  common  use  in  this  country  is  lead-free. 

Objection  on  the  ground  of  possible  contamination 
has  been  raised  to  the  use  of  solder  for  sealing  food 
cans.  Such  objections  have  less  weight  than  formerly 
owing  to  changes  in  the  construction  of  the  container, 
so  that  any  contact  of  solder  with  the  food  is  now 
minimized  and  to  a  large  extent  done  away  with 
altogether. 

In  consequence  of  the  fact  that  many  natural  waters 
attack  lead,  the  use  of  lead  service  pipes  for  wells, 
cisterns,  and  public  water  supplies  has  given  rise  to 
numerous  outbreaks  of  lead  poisoning.  It  is  now 
generally  recognized  that  water  intended  for  drinking 
purposes  should  not  be  drawn  through  lead  pipes. 

'  Harrington  and  Ricliardson,  Manual  of  Practical  Hygiene,  5th 
ed.,  p.  224. 


MINERAL  POISONS  ADDED  TO  FOOD  29 

A  special  liability  to  take  lead  into  the  stomach 
exists  in  persons  working  at  the  painters'  trade  and 
other  occupations  involving  contact  with  lead  and  its 
salts.  It  has  been  shown  that  the  eating  of  food  handled 
with  paint-smeared  hands  brings  about  the  ingestion 
of  considerable  quantities  of  lead  and,  when  long 
continued,  results  in  lead  poisoning.  The  risk  of  con- 
taminating food  with  lead  in  this  way  can  be  greatly 
lessened  by  thorough  cleansing  of  the  hands  with  soap 
and  hot  water  before  eating.^ 

TIN 

Special  interest  has  attached  to  the  possibility  of 
tin  poisoning  on  account  of  the  widespread  use  of  canned 
foods.^  It  is  established  chemically  that  tin  is  attacked, 
not  only  by  acid  fruits  and  berries,  but  by  some  vege- 
tables having  only  a  slightly  acid  reaction.  More  tin 
is  found  in  the  drained  solids  than  in  the  liquor,  and 
the  metal  is  largely  in  an  insoluble  form.^  It  has  been 
the  general  opinion  based  on  experiments  by  Lehmann'' 
and  others  that  the  amounts  of  tin  ordinarily  present 
in  canned  foods  "are  undeserving  of  serious  notice," 
and  this  view  has  found  expression  in  the  leading 
textbooks  on  hygiene.^  Certainly  there  has  not  been 
any  noticeable  amount  of  tin  poisoning  observed  coin- 
cident with  the  enormous  increase  in  the  use  of  canned 

'  See  Alice  Hamilton,  "Hygiene  of  the  Painters'  Trade,"  U.S. 
Bureau  of  Labor  Slatistics,  Bull.  120,  19 13. 

^  In  1909  the  value  of  foods  canned  in  the  United  States  amounted 
to  about  $300,000,000  (U.S.  Dept.  of  Agric,  Bull.  ig6,  1915). 

3  W.  D.  Bigelow,  Amcr.  Food  Jour.,  XI  (1916),  461. 

*Arcli.f.  Ilyg.,  XLV  (1902),  88;   ibid.,  LXIII  (1907),  G7. 

5  See,  e.g.,  Harrington  and  Richardson,  Practical  Hygiene,  5th 
ed.,  p.  274. 


30  FOOD  POISONING 

foods.  An  instance  of  poisoning  by  canned  asparagus 
observed  by  Friedmann/  however,  is  attributed  by  him 
to  the  tin  content,  and  this  view  is  rendered  probable  by 
the  negative  result  of  his  bacteriological  and  serological 
examinations.  Canned  asparagus  apparently  contains 
an  unusually  large  amount  of  soluble  tin  compounds,^ 
There  seems  some  ground  for  the  assumption  that 
certain  individuals  are  especially  susceptible  to  small 
quantities  of  tin  and  that  the  relative  infrequency  of 
such  cases  as  that  cited  by  Friedmann  can  be  best 
explained  in  this  way.  Lacquered  or  "enamel-lined" 
cans  are  being  used  to  an  increasing  extent  for  fruits 
and  vegetables  that  are  especially  likely  to  attack  tin.^ 
Intentional  addition  of  tin  salts  to  food  substances 
does  not  appear  to  be  common,  although  protochloride 
of  tin  is  said  sometimes  to  be  added  to  molasses  for 
the  purpose  of  reducing  the  color.  The  chlorides  are 
regarded  as  more  definitely  poisonous  than  other  com- 
pounds of  tin,  and  for  this  and  other  reasons  the  practice 
is  undesirable.  Sanitarians  insist  that  chemical  sub- 
stances likely  to  be  irritating  to  the  human  tissues  in 
assimilation  or  elimination  should  not  be  employed  in 
food.  Each  new  irritant,  even  in  small  quantity,  may 
add  to  the  burden  of  organs  already  weakened  by  age 
or  previous  harsh  treatment. 

COPPER 

Danger  is  popularly  supposed  to  attend  the  cooking 
and  especially  the  long  standing  of  certain  foods  in 
copper  vessels  on  account  of  the  verdigris  or  copper 

'Zlschr.f.  Ilyg.,  LXXV-LXXVI  (191.^-14),  55. 

^  Bigelow,  loc.  cil. 

3  A.  \V.  Bitting,  U.S.  Dcpl.  of  Agric,  Bull.  iy6,  1915. 


MINERAL  rOISONS  ADDED  TO  FOOD  31 

acetate  that  is  sometimes  formed,  but  Professor  Long, 
of  the  Referee  Board  of  Consulting  Scientific  Experts,' 
points  out  that  this  substance  is  far  less  toxic  than  it 
was  once  imagined  to  be,  and  he  considers  it  likely  that 
the  cases  of  illness  attributed  to  "verdigris  poisoning" 
reported  in  the  older  literature  should  have  been 
explained  in  some  other  way. 

The  use  of  copper  sulphate  for  imparting  a  green 
color  to  certain  vegetables,  such  as  peas,  beans,  and 
asparagus,  is  a  relatively  modern  practice,  having  been 
started  in  France  about  1850.  Since  the  natural  green 
of  vegetables  is  in  part  destroyed  or  altered  by  heat, 
restoration  of  the  color  has  appealed  to  the  color  sense  of 
some  consumers.  It  must  be  admitted  that  this  aesthetic 
gratification  is  fraught  with  some  degree  of  danger  to 
health.  The  experiments  by  Long  show  that  copper  is 
absorbed  and  retained  in  certain  tissues,  and  that  even 
small  amounts  ingested  at  brief  intervals  may  have  a 
deleterious  action.  He  concludes  that  the  use  of  copper 
salts  for  coloring  foods  must  be  considered  as  highly 
objectionable.  The  United  States  Government  now 
prohibits  the  importation  of  foods  colored  with  copper 
and  also  the  interstate  trade  in  these  substances. 

VARIOUS  COLORING  SUBSTANCES 

Copper  sulphate  is  but  one  of  a  host  of  chemical 
substances  applied  to  various  foods  for  the  purpose 
of  altering  the  color  which  the  foods  would  otherwise 
possess.  In  some  cases  perhaps  it  may  be  the  general 
opinion  that  by  special  treatment  the  attractiveness 
of  a  food  product  is  increased,  as  when  dark-colored 

'  U.S.  Dept.  of  Agric,  Report  97,  1913. 


32  FOOD  POISONING 

flour  is  bleached  white  with  nitrogen  peroxide,  but  in 
many  instances  the  modification  of  color  is  based  on 
preposterously  artificial  standards.  The  use  of  poison- 
ous aniline  dyes  for  staining  candies  all  the  colors  of  the 
rainbow  must  be  defended,  if  at  all,  on  aesthetic  rather 
than  on  sanitary  grounds.  Some  coloring  matters  in 
common  use,  such  as  the  annatto,  universally  employed  in 
coloring  butter,  are  believed  to  be  without  harmful  effect, 
but  others  are  to  be  viewed  with  suspicion,  and  still  others, 
like  copper  sulphate,  are  unquestionably  dangerous. 
The  whole  practice  of  food  coloration  at  its  best  involves 
waste  and  may  entail  serious  danger  to  health.  Broadly 
speaking,  all  modification  of  the  natural  color  of  food- 
stuffs is  based  on  an  idle  convention  and  should  be 
prohibited  in  the  interest  of  the  public  welfare. 
Bleached  flour,  stained  butter,  dyed  jelly  and  ice-cream 
are  no  whit  more  desirable  as  foods  than  the  natural 
untreated  substances;  in  fact,  they  are  essentially  less 
desirable.  If  the  whole  process  of  food  coloration  were 
known  to  the  public,  artificially  colored  foods  would 
not  be  especially  appetizing.  Economically  the  practice 
is  singularly  futile.  The  artificial  whitening  of  flour 
with  the  highly  poisonous  nitrogen  peroxide  seems 
hardly  worth  the  extra  tax  of  fifty  cents  to  a  dollar  a 
barrel.  Such  bleaching  with  a  poisonous  gas  certainly 
does  not  improve  the  nutritive  or  digestive  qualities  of 
flour;  it  may  be  insidiously  injurious.  The  solution  of 
the  problem  of  food,  coloration  seems  to  lie  in  a  policy 
of  educational  enlightenment  which  shall  make  natural 
foods  appear  more  desirable  than  those  sold  under  false 
colors.  Custom,  however,  buttressed  by  skilful  adver- 
tising, offers  a  difficult  barrier  to  reform  in  this  field. 


MINERAL  POISONS  ADDED  TO  FOOD  ^^ 

FOOD    PRESERVATIVES 

It  is  not  only  legitimate,  but  in  every  way  most 
desirable,  to  keep  food  over  from  a  season  of  super- 
abundance to  a  season  of  scarcity.  From  time  imme- 
morial food  has  been  preserved  by  drying,  smoking,  or 
salting,  and,  in  modern  times,  by  refrigeration  and  by 
heat  (canning).  These  latter  methods  have  come  to 
play  a  large  part  in  the  food  habits  of  civilized  com- 
munities. Since  food  spoils  because  of  microbic  action, 
all  methods  of  preservation  are  based  upon  the  destruc- 
tion of  the  microbes  or  the  restraint  of  their  growth  by 
various  physical  and  chemical  agencies.  The  use  of 
certain  chemical  preservatives  such  as  strong  sugar  and 
salt  solutions,  saltpeter  brines,  and  acid  pickles  has  long 
beeti  known  and  countenanced.  In  recent  times  the 
emplo^Tnent  of  chemical  preservatives  has  acquired  a 
new  aspect  through  the  increasing  tendency  of  manu- 
facturers to  add  to  food  products  antiseptic  chemicals 
in  wide  variety  and  of  dubious  physiological  effect. 

It  is  not  so  easy  and  simple  as  it  might  appear  to 
declare  that  no  substance  that  is  poisonous  shall  be 
added  to  food.  The  scientific  conception  of  a  poison 
is  one  involving  the  amount  as  well  as  the  kind  of  sub- 
stance. Common  salt  itself  is  poisonous  in  large  doses, 
but,  as  everyone  knows,  small  amounts  are  not  only  not 
injurious,  but  absolutely  necessary  to  health.  Well- 
known  and  very  powerful  protoplasmic  poisons  such  as 
strychnine  and  quinine  are  frequently  administered  in 
minute  doses  for  medicinal  purposes,  without  causing 
serious  results. 

How  comphcated  the  question  of  using  food  pre- 
servatives really  is  appears  in  the  case  of  smoked  meats 


34  FOOD  POISONING 

and  fish,  which  owe  their  keeping  qualities  to  the  creosote 
and  other  substances  with  which  they  are  impregnated 
by  the  smoke.  Although  these  substances  are  much 
more  highly  poisonous  than  chemical  preservatives  like 
benzoic  acid,  over  which  much  concern  has  been  ex- 
pressed, but  httle  if  any  objection  has  been  made  to 
the  use  of  smoked  foods. 

The  use  of  benzoic  acid  (benzoate  of  soda)  as  a 
food  preservative  illustrates  several  phases  of  the  con- 
troversy. Observations  by  Wiley  in  1908  upon  so-called 
"poison  squads"  were  thought  by  him  to  indicate 
that  benzoate  of  soda  administered  with  food  led  to 
"a  very  serious  disturbance  of  the  metabolic  functions, 
attended  with  injury  to  digestion  and  health."  On 
the  other  hand,  the  experiments  of  the  Referee  Board 
of  Scientific  Experts  (1909),  conducted  with  at  least 
equal  care  and  thoroughness,  were  considered  to  warrant 
the  conclusions  that: 

(i)  Sodium  benzoate  in  small  doses  (under  five-tenths  of  a 
gram  per  day)  mixed  with  the  food  is  without  deleterious  or 
poisonous  action  and  is  not  injurious  to  health.  (2)  Sodium 
benzoate  in  large  doses  (up  to  four  grams  per  day)  mixed  with  the 
food  has  not  been  found  to  exert  any  deleterious  effect  on  the 
general  health,  nor  to  act  as  a  poison  in  the  general  acceptance 
of  the  term.  In  some  directions  there. were  slight  modifications 
in  certain  physiological  processes,  the  exact  significance  of  which 
modification  is  not  known.  (3)  The  admixture  of  sodium  ben- 
zoate with  food  in  small  or  large  doses  has  not  been  found  to 
injuriously  affect  or  impair  the  quality  or  nutritive  value  of 
such  food. 

Still  later  experiments  under  the  auspices  of  the 
German  government  (1913)  showed  that  in  the  case  of 
dogs  and  rabbits  relatively  large  doses  of  benzoic  acid 


MINERAL  POISONS  ADDED  TO  FOOD  35 

(corresponding  to  sixty  to  one  hundred  grams  per  day 
for  a  man  weighing  one  hundred  and  fifty  pounds)  were 
necessary  in  order  to  produce  demonstrable  effects  of 
any  kind.  This  finding  may  be  considered  to  confirm 
in  a  general  way  the  finding  of  the  Referee  Board  that 
four  grams  per  day  is  harmless. 

Probably  the  evidence  respecting  the  effect  of 
benzoic  acids  and  the  benzoates  when  used  as  food 
preservatives  constitutes  as  favorable  a  case  as  can  be 
made  out  at  the  present  time  for  the  employment  of  any 
chemical  substance.  Benzoic  acid  is  present  in  note- 
worthy amounts  in  many  fruits  and  berries,  especially 
cranberries,  and  its  presence  in  these  natural  foods  has 
never  been  connected  with  any  injurious  action.  In 
point  of  fact,  substances  present  in  many  ordinary  food- 
stuffs are  converted  within  the  human  body  first  into 
benzoic  acid  and  then  into  hippuric  acid.  Folin's 
masterly  summing  up  is  worth  quoting: 

We  know  that  the  human  organism  is  prepared  to  take  care 
of  and  render  harmless  those  small  quantities  of  benzoic  acid 
and  benzoic  acid  compounds  which  occur  in  food  products  or 
which  are  formed  within  the  body;  we  know  how  this  is  accom- 
plished and  are  reasonably  sure  as  to  the  particular  organ  which 
does  it.  We  also  know  that  the  mechanism  by  means  of  which 
the  poisonous  benzoic  acid  is  converted  into  the  harmless  hippuric 
acid  is  an  extremely  efficient  one,  and  that  it  is  capable  of  taking 
care  of  relatively  enormous  quantities  of  benzoic  acid.  In  this 
case,  as  in  a  great  many  others,  the  normal  animal  organism  is 
abundantly  capable  of  performing  the  function  which  it  must 
regularly  perform  in  order  to  survive.  From  this  point  of  view 
it  can  be  argued,  and  it  has  been  argued  with  considerable  force, 
that  the  human  organism  is  abundantly  capable  of  rendering 
harmless  reasonable  amounts  of  benzoic  acid  or  benzoate  which 
are  added  for  purposes  of  [)reservation  to  certain  articles  of  our 


36  FOOD  POISONING 

food.  In  my  opinion  this  point  of  view  is  going  to  prevail,  and 
the  strife  will  resolve  itself  into  a  controversy  over  how  much 
benzoic  acid  shall  be  permitted  to  go  into  our  daily  food. 

But  we  ought  to  be  exceedingly  cautious  about  accepting 
any  definite  figure,  certainly  any  large  figure,  as  representing  the 
permissible  amount  of  added  benzoic  acid  in  our  food.  The 
very  fact  that  we  are  in  possession  of  an  efficient  process  for 
converting  poisonous  benzoic  acid  into  harmless  hippuric  acid 
indicates  that  there  is  a  necessity  for  doing  so.  It  suggests  that 
even  the  small  quantities  of  benzoic  acid  which  we  get  with 
unadulterated  food,  or  produce  within  ourselves,  might  be  delete- 
rious to  health  except  for  the  saving  hippuric  acid  forming  process. 
And  because  that  "factor  of  safety"  is  a  large  one  with  respect 
to  the  normal  benzoic  acid  content  of  our  food  it  does  not  follow 
that  we  can  encroach  on  it  with  perfect  impunity.  What  the 
effect  of  a  general,  regular  encroachment  on  it  would  be  cannot 
be  determined  by  a  few  relatively  short  feeding  experiments. 
It  is  known  that  while  certain  chemicals  may  be  taken  in  sub- 
stantial quantities  for  a  month  or  a  year  without  producing 
demonstrably  injurious  effects,  nevertheless  the  continued  use 
of  the  same  substances,  even  in  smaller  quantities,  will  eventually 
undermine  the  health.  Perhaps  the  final  solution  of  the  benzoic 
acid  problem  could  be  best  obtained  directly  from  the  people 
at  large.  If  they  were  to  consume  benzoic  acid  as  knowingly 
as  they  consume,  for  example,  sodic  carbonate  in  soda  biscuits, 
or  caffeine  and  theobromine  in  coffee  and  tea,  it  would  not  require 
more  than  a  decade  or  two  before  we  should  have  a  well-defined 
and  well-founded  public  opinion  on  the  subject,  at  least  in  the 
medical  profession.' 

With  respect  to  other  famihar  and  more  or  less 
poisonous  substances  used  to  preserve  foods,  defense 
of  their  harmlessness  is  far  more  difficult.  Formalde- 
hyde, saHcyhc  acid,  sulphurous  acid,  and  sulphite  are 
compounds    definitely    poisonous    in    relatively    small 

'  Folin,  Preservatives  and  Oilier  Chemicals  in  Foods  (Harvard 
University  Press,  19 14),  p.  32. 


MINERAL  POISONS  ADDED  TO  FOOD  37 

amounts,  their  injurious  action  in  minute  successive 
doses  in  animal  experiments  is  quite  marked,  and  their 
use  in  human  food  products  practically  without  justifi- 
cation. Boric  acid  and  borax  are  perhaps  on  a  slightly 
different  footing,  but  are  never  present  in  natural 
foods,  and  there  is  no  good  evidence  that  their  long- 
continued  ingestion  in  small  doses  is  without  injurious 
effect.  It  must  not  be  forgotten  that  all  such  substances 
owe  their  preservative  or  antiseptic  power  to  the  poison- 
ous eft"ect  they  have  upon  bacterial  protoplasm.  It 
is  fair  to  assume  that,  in  general,  bacterial  protoplasm 
is  no  more  easily  injured  than  human  protoplasm,  and 
this  raises  at  once  the  propriety  of  bringing  into  repeated 
contact  with  human  tissues  substances  likely  to  produce 
injury  even  if  such  injury  is  slight  and  recovery  from  it 
is  ordinarily  easy.  In  every  case  the  burden  of  proof 
should  be  properly  placed  on  those  who  advocate  the 
addition  of  bacterial-restraining  substances  to  food 
intended  for  human  consumption.  It  is  for  them  to 
show  that  substances  powerful  enough  to  hold  in  check 
the  development  of  bacteria  are  yet  unable  to  interfere 
seriously  with  the  life-processes  of  the  cells  of  the  human 
body. 

When  this  view  of  the  situation  is  taken,  not  only 
the  chemical  substances  mentioned  previously  fall  under 
some  suspicion,  but  also  certain  household  preservatives 
long  sanctioned  by  custom.  Spices  such  as  cinnamon, 
oil  of  cloves,  and  the  like  are,  so  far  as  we  know,  as 
likely  to  have  an  injurious  physiological  effect  when 
taken  in  small  recurring  quantities  as  are  some  of  the 
"chemical"  preservatives  whose  use  is  debarred  by 
law.     The  chemicals  deposited  by  wood  smoke  in  meat 


38  FOOD  POISONING 

are  of  a  particularly  objectionable  nature,  and  their 
continuous  ingestion  may  quite  conceivably  lead  to 
serious  injury. 

One  fact  persistently  comes  to  the  front  in  any 
comprehensive  study  of  the  food-preservative  question, 
namely,  the  need  of  further  experiment  and  observation. 
We  do  not  at  present  know  what  effect  is  produced 
in  human  beings  of  different  ages  and  varying  degrees 
of  strength  by  the  long-continued  consumption  of  food 
preserved  with  particular  chemicals. 

There  is,  I  think,  only  one  way  to  get  at  the  facts  with  regard 
to  the  various  chemicals  which  have  been  used  for  the  preserva- 
tion of  foods,  and  that  is  by  trying  them  and  keeping  track  of 
the  results.  To  try  them  properly,  on  a  sufficiently  extensive 
scale  and  for  a  sufficiently  long  time,  is,  however,  more  of  a  task 
than  can  be  undertaken  by  private  investigators;  for  it  is  only 
by  their  continuous  use  for  many  years  under  competent  super- 
vision and  control  that  we  can  hope  to  attain  adequate  informa- 
tion for  final  conclusions.  Work  of  this  sort  should  be  done 
and  could  very  well  be  done  at  large  government  institutions, 
as,  for  example,  among  certain  classes  of  prison  inmates.  I  do 
not  know  how  many  life  prisoners  or  long-term  prisoners  may  be 
available,  but  there  must  be  an  abundance  of  them.  They 
would  make  better  subjects  than  students  on  whom  to  try  out 
a  substance  like  boric  acid.  This,  not  because  they  are  prisoners 
whose  fate  or  health  is  of  comparatively  little  consequence,  but 
because  they  represent  a  body  of  persons  whose  mode  of  life  is 
essentially  uniform  and  whose  health  record  could  easily  be  kept 
for  a  long  period  of  years.  I  am  well  aware  that  this  suggestion 
will  impress  many  persons  as  heartless  and  brutal,  but  such  an 
experiment  would  be  a  mild  and  humane  one  when  compared 
with  the  unrecorded  boric  acid  experiments  which  have  been 
made  by  manufacturers  on  all  kinds  and  conditions  of  people. 
Prisoners  are  unfortunate  in  not  being  able  to  render  any  useful 
service  to  society.  Probably  not  a  few  would  be  willing  to 
co-operate  in  prolonged  feeding  experiments,  similar  to  the  short 


IMINERAL  POISONS  ADDED  TO  FOOD  39 

ones  conducted  by  Dr.  Wiley  and  by  the  Referee  Board.  Accept- 
able reward  in  the  way  of  well-prepared  food  of  sufficient  variety 
would  attract  volunteers.  If  additional  inducement  were  neces- 
sary, shortened  term  of  service  would  probably  appeal  to  many. 
And  in  the  face  of  the  fact  that  every  civilized  country  is  prepared 
to  sacrifice  thousands  of  its  most  virile  citizens  for  the  honor  of  its 
flag  (and  its  foreign  trade),  the  sentiment  against  endangering 
the  health  of  a  handful  of  men  in  the  interest  of  all  mankind  is 
not  particularly  intelligent.' 

Until  such  information  is  forthcoming  we  do  well 
to  err  on  the  side  of  caution.  The  desirability  of  adopt- 
ing this  attitude  is  especially  borne  in  upon  us  by  the 
facts  already  instanced  (pp.  2-4)  concerning  the  increased 
death-rates  in  the  higher-age  groups  in  this  country. 
For  aught  v^e  now  know  to  the  contrary,  the  relatively 
high  death-rates  from  degenerative  changes  in  the 
kidneys,  blood  vessels,  and  other  organs  may  be  in  part 
caused  by  the  use  of  irritating  chemical  substances  in 
food.  Although  no  one  chemical  by  itself  and  in  the 
quantities  in  which  it  is  commonly  present  in  food  can 
perhaps  be  reasonably  accused  of  producing  serious  and 
permanent  injury,  yet  when  to  its  effect  is  superadded 
the  effect  of  still  other  poisonous  ingredients  in  spiced, 
smoked,  and  preserved  foods  of  all  kinds  the  total  burden 
laid  upon  the  excretory  and  other  organs  may  be  dis- 
tinctly too  great.  There  can  be  no  escape  from  the 
conclusion  that  the  more  extensive  and  widespread  the 
use  of  preservatives  in  food  the  greater  the  likelihood 
of  injurious  consequences  to  the  public  health. 

The  use  of  spoiled  or  decomposed  food  falls  under 
the  same  head.  It  cannot  be  assumed  that  the  irritating 
substances  produced  in  food  by  certain  kinds  of  decom- 

'  Folin,  op.  ciL,  p.  42. 


40  FOOD  POISONING 

position  can  be  continually  consumed  with  impunity. 
We  do  not  even  know  whether  these  decomposition 
products  may  not  be  more  fundamentally  injurious 
than  preservatives  that  might  be  added  to  prevent 
decomposition ! 

So  far  as  our  present  knowledge  indicates,  therefore, 
effort  should  be  directed  (i)  to  the  purveying  of  food 
as  far  as  possible  in  a  fresh  condition;  (2)  to  the  avoid- 
ance of  chemical  preservatives  of  all  kinds  except  those 
unequivocally  demonstrated  to  be  harmless.  The  meth- 
ods of  preserving  food  by  drying,  by  refrigeration,  and 
by  heating  and  sealing  are  justified  by  experience  as 
well  as  on  theoretical  grounds,  and  the  same  state- 
ment can  be  made  regarding  the  use  of  salt  and  sugar 
solutions.  But  the  use  of  sulphites  in  sausage  and 
chopped  meat,  the  addition  of  formaldehyde  to  milk, 
and  of  boric  acid  or  sodium  fluoride  to  butter  are  prac- 
tices altogether  objectionable  from  the  standpoint  of 
pubhc  health. 

The  remedy  is  obvious  and  has  been  frequently 
suggested — namely,  laws  prohibiting  the  addition  of 
any  chemical  to  food  except  in  certain  definitely  speci- 
fied cases.  The  presumption  then  would  be — ^as  in 
truth  it  is — ^that  such  chemicals  are  more  or  less  dan- 
gerous, and  proof  of  innocuousness  must  be  brought 
forward  before  any  one  substance  can  be  listed  as  an 
exception  to  the  general  rule.  Such  laws  would  include 
not  only  the  use  of  chemicals  or  preservatives,  but  the 
employment  of  substances  to  "improve  the  appearance" 
of  foodstuffs.  As  already  pointed  out,  the  childish 
practice  of  artificially  coloring  foods  involves  waste 
and    sometimes   danger.     It   rests   on   no    deep-seated 


MINERAL  POISONS  ADDED  TO  FOOD  41 

human  need;  food  that  is  natural  and  un tampered 
with  may  be  niade  the  fashion  just  as  easily  as  the  color 
and  cut  of  clothing  are  altered  by  the  fashion-monger. 
The  incorporation  of  any  chemical  substance  into  food 
for  preservative  or  cosmetic  purposes  could  wisely  be 
subject  to  a  general  prohibition,  and  the  necessary  list 
of  exceptions  (substances  such  as  sugar  and  salt)  should 
be  passed  on  by  a  national  board  of  experts  or  by  some 
authoritative  organization  like  the  American  Public 
Health  Association. 

FOOD    SUBSTITUTES 

On  grounds  of  economy  or  convenience  familiar  and 
natural  articles  of  food  are  sometimes  replaced  or  supple- 
mented by  artificial  chemical  products,  or  by  substances 
whose  food  value  is  not  so  definitely  established.  I 
need  refer  only  briefly  to  those  notorious  instances  of 
adulteration  in  which  chicory  is  added  to  cofifee,  or 
ground  olive  stones  to  pepper,  or  glucose  to  candy.  On 
hygienic  grounds  alone  some  such  practices  are  not 
open  to  criticism,  however  fraudulent  they  may  be 
from  the  standpoint  of  public  morals.  It  might  be 
argued  with  some  plausibility  that  chicory  is  not  so 
likely  to  harm  the  human  organism  as  caffeine  and  that 
sprinklings  of  ground  cocoanut  shell  are  more  whole- 
some than  pepper.  But  there  is  another  group  of  cases 
in  which  the  artificial  substitute  is  strictly  objectionable. 
The  use  of  the  coal-tar  product  saccharin  for  sweetening 
purposes  is  an  example.  This  substance,  whose  sweeten- 
ing power  is  five  hundred  times  as  great  as  that  of  cane 
sugar,  has  no  nutritive  value  in  the  quantities  in  which 
it  would  be  consumed,  and  in  not  very  large  quantities 


42  FOOD  POISONING 

(over  0.3  gram  per  day)  is  likely  to  induce  disturbance 
of  digestion.  As  a  substitute  for  sugar  in  ordinary 
foodstuffs  it  is  undesirable.' 

The  use  of  cheap  chemically  prepared  flavors  such  as 
"fruit  ethers"  in  "soft  drinks,"  fruit  syrups,  and  the 
like  in  place  of  the  more  expensive  natural  fruit  extracts 
affords  another  well-known  instance  of  substitution. 
Probably  more  important  hygienically  is  the  production 
of  "foam"  in  "soda  water"  by  saponin,  a  substance 
known  to  be  injurious  for  red  blood  corpuscles. 

Among  the  many  other  familiar  examples  of  food 
substitution,  sophistication,  and  adulteration  there  are 
some  of  demonstrable  hygienic  disadvantage  and  others 
whose  chief  demerit  lies  in  simple  deception.  Of  prac- 
tically all  it  may  be  said  that  they  are  indefensible  from 
the  standpoint  of  public  policy  since  they  are  based  on 
the  intent  to  make  foodstuffs  appear  other  than  what 
they  really  are. 

It  is  the  opinion  of  some  who  have  closely  followed 
the  course  of  food  adulteration  that,  while  the  amount 
of  general  sophistication — ^legally  permissible  and  other- 
wise— has  greatly  increased  in  recent  years,  the  propor- 
tion of  really  injurious  adulteration  has  fallen  off.  Be 
that  as  it  may,  it  is  plain  that  the  opportunity  for  whole- 
sale experimentation  with  new  substances  should  not 
be  allowed  to  rest  without  control  in  the  hands  of  manu- 
facturers and  dealers  largely  impelled  by  commercial 
motives.  So  long  as  the  motive  of  gain  is  allowed  free 
scope,  so  long  will  a  small  minority  of  unscrupulous 
persons  add  cheap,  inferior,  and  sometimes  dangerous 
ingredients  to  foodstuffs.     The  net  of  restriction  must 

'  See  U.S.  Dept.  of  Agric,  Report  94,  191 1. 


MINERAL  POISONS  ADDED  TO  FOOD  43 

be  drawn  tighter  and  tighter.  The  motives  leading 
to  the  tampering  with  food  fall  mainly  under  three 
heads:  (i)  a  desire  to  preserve  food  from  spoiling  or 
deterioration;  (2)  a  puerile  fancy — often  skilfully 
fostered  for  mercenary  reasons — for  a  conventional 
appearance,  as  for  polished  rice,  bleached  flour,  and 
grass-green  peas;  and  (3)  intent  to  make  the  less  valuable 
appear  more  valuable — ^deliberate  fraud.  Only  the 
first-named  motive  can  claim  any  legitimate  justifica- 
tion, and  its  gratification  by  the  use  of  chemical  pre- 
servatives is  surrounded  with  hygienic  difficulties  and 
uncertainty,  as  already  set  forth.  From  the  unbiased 
view  of  human  physiology  the  dangers  of  slow  poisoning 
from  chemically  treated  foods  must  be  regarded  as  no 
less  real  because  they  are  insidious  and  not  easily  traced. 


CHAPTER  V 
FOOD-BORNE  PATHOGENIC  BACTERIA 

Many  cases  of  so-called  food  poisoning  are  due  to 
the  presence  of  pathogenic  bacteria  in  the  food.  In 
some  instances,  as  in  the  typical  meat  poisoning  epidem- 
ics, symptoms  develop  so  soon  after  eating  that  the 
particular  food  involved  is  immediately  suspected  and 
laid  hands  on.  In  other  cases  the  guilty  article  of  food 
is  difficult  to  trace.  Certain  cases  of  tuberculosis  are 
undoubtedly  caused  by  swallowing  tubercle  bacilli 
in  the  food,  but  the  precise  source  and  date  of  infection 
can  be  rarely,  if  ever,  certainly  established. 

The  presence  of  pathogenic  bacteria  in  food  is 
usually  due  either  to  the  contamination  of  the  food  by 
infected  human  beings  during  the  process  of  preparation 
or  serving,  or  to  an  infection  of  the  animal  from  which 
the  food  is  derived.  The  relative  importance  of  these 
two  factors  is  quite  different  in  the  various  infections. 

TYPHOID   FOOD   INFECTION 

The  typhoid  bacillus  does  not  attack  any  of  the 
domestic  animals;  consequently  all  food-borne  typhoid 
is  caused  more  or  less  directly  by  human  contamination. 
A  remarkable  instance  of  typhoid  infection  due  to  food 
was  reported  in  19 14  in  Hanford,  California,  where 
ninety-three  typhoid  cases  were  caused  by  eating 
Spanish  spaghetti  served  at  a  public  dinner.^  Investi- 
gation showed  that  this  dish  was  prepared  by  a  woman 

'  Sawyer,  Jour.  Amer.  Med.  Assoc,  LXIII  (1914),  1537. 
44 


FOOD-BORNE  PATHOGENIC  BACTERIA  45 

typhoid-carrier  who  was  harboring  living  typhoid  ba- 
cilH  at  the  time  she  mixed  the  sauce  for  the  spaghetti 
before  baking.  Further  laboratory  experiments  indi- 
cated that  the  ordinary  baking  temperature  at  which 
the  spaghetti  was  cooked  was  not  only  not  sufficient  to 
sterilize  the  food,  but  afforded  a  favorable  opportunity 
for  the  bacteria  in  the  interior  of  the  mass  to  multiply. 
The  infection  of  the  food  was  consequently  heavy  and 
involved  a  very  large  proportion  (57  per  cent)  of  those 
present  at  the  dinner. 

Merited  celebrity  attaches  to  the  exploits  of  the 
typhoid-carrier,  Mary  Malloy,  who,  in  pursuing  her 
career  as  cook  in  and  about  New  York  City,  is  known  to 
have  caused  at  least  seven  t>^hoid  outbreaks  in  various 
families  in  which  she  worked  and  one  extensive  hospital 
epidemic.  Similar  cases  of  typhoid  food  infection  by 
employees  in  restaurants  and  public  institutions  are 
by  no  means  uncommon,  and  show  the  necessity  of 
protecting  food  from  contamination  during  the  whole 
process  of  preparation  and  serving.  Acting  on  this 
principle,  the  Department  of  Health  of  New  York  City 
has  inaugurated  a  comprehensive  examination  of  the 
cooks  and  waiters  (approximately  90,000)  employed 
in  the  pubHc  restaurants  and  dining-rooms  in  that  city. 
Results  have  been  obtained  in  the  discovery  of  typhoid- 
carriers  and  of  cases  of  communicable  disease  that 
amply  justify  this  procedure  as  an  important  measure 
for  protectmg  the  community  against  the  dissemination 
of  infection. 

Some  foods  by  their  origin  are  exposed  more  than 
others  to  typhoid  contamination.  Such  vegetables  as 
lettuce,    celery,    radishes,    and    watercress,    which    are 


46  FOOD  POISONING 

commonly  eaten  without  cooking,  are  more  likely 
to  convey  typhoid  than  peas,  beans,  and  potatoes.  A 
typhoid  outbreak  apparently  due  to  watercress  has 
been  reported  from  Philadelphia.^  At  a  wedding  break- 
fast to  forty-three  guests  on  June  24,  19 13,  water- 
cress sandwiches  were  served,  and  subsequent  inquiry 
showed  that  nineteen  of  the  guests  partook  of  these 
sandwiches.  Eighteen  of  this  number  became  ill  with 
typhoid  fever  within  a  month,  the  illness  developing  in 
most  cases  after  the  guests  had  scattered  to  their  summer 
homes.  Those  who  did  not  eat  watercress  sandwiches 
were  not  affected.  Typhoid  infection  by  uncooked 
celery  has  also  been  reported.^ 

The  practice  of  using  human  excreta  as  fertilizer  in 
truck  gardens  is  sometimes  responsible  for  a  danger- 
ous contamination  of  the  soil,  which  is  communicated 
to  the  growing  plants  and  persists  for  a  long  time.^ 
Even  scrupulous  washing  of  vegetables  is  not  sufh- 
cient  to  render  them  bacterially  clean.  In  the  future 
the  danger  to  the  community  from  this  source  is  likely 
to  become  increasingly  serious  unless  the  growing  use  of 
this  method  of  soil  enrichment  is  definitely  checked. 

In  191 5  an  increasing  number  of  typhoid  cases  in 
South  Philadelphia  led  to  an  investigation  by  the  state 
health  department.'^  This  disclosed  the  fact  that  the 
majority  of  the  cases  were  clustered  in  and  about  three 
public  markets. 

'  Eng.  News,  LXX  (1913),  322. 

"  Morse,  Report  of  Stale  Board  of  Health  of  Mass.,  1S99,  p.  761. 

3  R.  H.  Creel,  Reprint  from  Public  Health  Reports;  No.  72,  Washing- 
ton, 1912. 

*  Health  Bull.  No.  yd,  Pennsylvania  Stale  Department  of  Health, 
December,  1915. 


FOOD-BORNE  PATHOGENIC  BACTERIA  47 

These  are  all  curb  markets — fruits,  vegetables,  pastry, 
clothing,  and  miscellaneous  merchandise  of  every  description  are 
dumped  on  push-carts  and  pavements  without  regard  for  any 
sanitary  precautions.  The  patrons  of  these  markets  handle 
and  pick  over  the  exposed  foodstuffs,  thus  giving  every  opportunity 
for  the  transmission  of  disease 

The  greatest  number  of  cases  occurred  in  the  immediate 
vicinity  of  the  Christian  Street  Market.  This  market  is  largely 
patronized  by  the  inhabitants  of  the  section  known  as  "Little 
Italy."  The  patrons  of  the  South  Street  Market  are  principally 
Hebrews,  while  the  Seventh  Street  Market  is  patronized  in  the 
main  by  Hebrews  and  Poles. 

The  following  conclusion  was  reached  regarding  the 
particularly  large  number  of  cases  among  persons  of 
one  nationality: 

Our  inspectors  have  found  that  the  different  methods  used 
by  the  Italians  and  Hebrews  in  the  preparation  of  their  food  are 
responsible  for  the  larger  number  of  cases  being  found  in  the 
vicinity  of  the  Christian  Street  Market  in  Little  Italy.  It  is  the 
custom  of  the  Italians  to  eat  many  of  the  fruits  and  vegetables 
raw,  while  the  Hebrews  cook  the  greater  portion  of  their  food. 
It  is  presumably  due  to  this  custom  that  the  members  of  the 
Italian  colony  have  suffered  to  a  greater  extent  than  the  other 
residents  of  the  district. 

A  bacterial  examination  of  various  kinds  of  vege- 
tables obtained  from  push-carts  and  curb  markets  led 
to  the  finding  of  the  typhoid  bacillus  upon  some  of 
the  celery.  It  would  naturally  be  difificult  to  determine 
in  such  cases  whether  the  typhoid  bacilli  were  derived 
from  infected  soil  in  which  the  celery  was  grown  or 
whether  the  contamination  occurred  through  improper 
handling. 

Bread,  when  marketed  unwrapped,  is  subject  to 
contamination  from  flies  and  from  uncleanly  handling. 


48  FOOD  POISONING 

Katharine  Howell'  has  shown  that  unwrapped  loaves 
of  bread  sold  in  Chicago  were  more  or  less  thickly 
smeared  with  bacteria  and  were  coated  on  the  average 
with  a  much  larger  number  than  wrapped  loaves.  In 
some  cases  typhoid  fever  has  been  directly  traced  to 
bread.  Hinton^  has  recorded  the  occurrence  of  seven 
typhoid  cases  in  the  Elgin  (IlHnois)  State  Hospital, 
which  were  apparently  due  to  a  typhoid-carrier  whose 
duty  it  was  as  attendant  to  slice  the  bread  before  serving. 
When  this  typhoid-bearing  attendant  was  transferred 
to  another  department  where  she  handled  no  uncooked 
food,  cases  of  typhoid  ceased  to  appear.^ 

Food  such  as  milk  that  is  not  only  eaten  custom- 
arily without  cooking,  but  is  also  suitable  for  the 
growth  of  typhoid  bacilli,  needs  to  be  particularly  safe- 
guarded. It  is  noteworthy  that  the  compulsory  pas- 
teurization of  milk  m  New  York,  Chicago,  and  other 
large  American  cities  has  been  accompanied  by  a  great 
diminution  in  the  prevalence  of  typhoid  fever.  Until 
recent  years  milk-borne  typhoid  in  the  United  States 
has  been  common  and  hundreds  of  typhoid  epidemics 
have  been  traced  to  this  source. 

One  food  animal,  the  oyster,  frequently  eaten  raw, 
has  been  connected  on  good  evidence  with  certain 
typhoid  outbreaks.''     The  number  of   well-established 

'  Amer.  Jour.  Public  Health,  II  (191 2),  321. 
^Institution  Quarterly,  III  (19 12),  18. 

3  See  also  a  similar  instance  reported  by  Lumsden,  Hyg.  Lab.,  U.S. 
Public  Health  and  Marine  Hosp.  Service,  Bull.  78,  p.  165. 

4  For  a  discussion  of  the  oyster  question  see  G.  W.  Fuller,  Jour, 
of  Franklin  Institute,  August,  1905;  N.Y.  City  Dept.  of  Health,  Monthly 
Bull.,  November,  1913,  and  May,  1915;  H.  S.  Gumming,  U.S.  Public 
Health  Service,  Pub.  Health  Bull.  74,  March,  1916. 


I'OOD-BORNE  PATHOGENIC  BACTERIA 


49 


oyster  typhoid  epidemics  is  not  great,  however,  and 
the  danger  from  this  source  has  sometimes  been  ex- 
aggerated. The  source  of  oyster  contamination  is  in 
sewage  polhition  either  of  the  shellfish  beds  or  of  the 


Fig.   5. — Bacteria   left   b}-   fly   passing  over  gelatin   plate.     (By 
courtesy  of  Doubleday,  Page  &  Company.) 

brackish  water  in  which  the  oyster  is  sometimes  placed 
to  "fatten"  before  it  is  marketed.  State  and  federal 
supervision  of  the  oyster  industry  in  the  United  States 
in  recent  years  has  largely  done  away  with  the  taking 
of  oysters  from  infected  waters,  and  although  oysters — • 


50  FOOD  POISONING 

and  clams  and  mussels  as  well — ^must  be  steadily  safe- 
guarded against  sewage  contamination,  the  actual 
occurrence  of  oyster  infection  at  the  present  time  is 
believed  to  be  relatively  rare. 

Probably  the  most  effective  method  of  preventing 
typhoid  food  infection  is  to  investigate  every  case  of 
typhoid  fever  and  trace  it,  so  far  as  practicable,  to  its 
origin.  In  this  way  typhoid-carriers  may  be  discovered 
and  other  foci  of  infection  brought  to  light.  Carriers, 
once  found,  may  be  given  proper  advice  and  warned 
that  they  constitute  a  danger  to  others;  the  complete 
control  of  typhoid-carriers  who  are  not  disposed  to  act 
as  advised  is  a  difificult  problem  and  one  not  yet  solved 
by  public  health  authorities. 

ASIATIC   CHOLERA 

With  Asiatic  cholera,  just  as  with  typhoid  fever, 
domestic  animals  are  not  susceptible  to  the  disease, 
all  cases  of  infection  having  a  direct  human  origin. 
Drinking-water  is  the  usual  vehicle  of  cholera  infection, 
and  even  in  countries  where  the  disease  is  endemic,  food- 
borne  outbreaks  of  this  disease  are  far  less  common 
than  those  of  t^q^hoid  fever.  Occasional  instances  of 
Asiatic  cholera  due  to  milk  supply  and  to  contaminated 
fruits  or  lettuce  are  on  record,  but  these  are  exceptional 
and  cannot  be  regarded  as  exemplifying  a  common 
mode  of  spread  of  this  disease.  The  extent,  however,  to 
which  dwellers  in  tropical  countries — ^and  indeed  in 
all  lands — ^are  at  the  mercy  of  their  household  helpers 
is  illustrated  by  the  following  experience  of  the  English 
bacteriologist,  Hankin.  "I  have  seen,"  he  says,  "a 
cook  cooling  a  jelly  by  standing  it  in  a  small  irrigation 


FOOD-BORNE  PATHOGENIC  BACTERIA  51 

ditch  that  ran  in  front  of  his  cookhouse.  The  water 
running  in  this  drain  came  from  a  well  in  which  I  had 
detected  the  cholera  microbe.  He  cleaned  a  spoon 
by  dipping  it  in  the  drain  and  rubbing  it  with  his  lingers; 
then  he  used  it  to  stir  the  jelly. "^ 

TUBERCULOSIS 

Animal  experiments  have  shown  that  both  meat  and 
milk  derived  from  tuberculous  cattle  are  capable  of 
conveying  infection.  The  precise  degree  of  danger 
to  human  beings  from  the  use  of  these  foods  under 
modern  conditions  is  still  in  dispute.  Since  the  tubercle 
bacillus  of  bovine  origin  differs  from  the  tubercle  bacillus 
of  human  origin  in  certain  well-defined  particulars,  it  is 
possible  by  careful  study  to  distinguish  the  human 
infections  caused  by  the  bovine  bacillus  from  those 
caused  by  the  so-called  human  tubercle  bacillus.  Addi- 
tional comparative  investigations  are  needed  in  this  field, 
and  these  may  enable  us  to  estimate  eventually  more 
fully  than  is  possible  at  present  the  extent  of  human 
tuberculous  infection  derived  from  bovine  sources. 

Meat  is  a  less  likely  source  of  infection  than  milk, 
chiefly  because  it  is  rarely  eaten  without  cooking. 
Opinion  regarding  the  actual  frequency  of  the  trans- 
mission of  tuberculosis  by  means  of  the  meat  of  tubercu- 
lous cattle  has  been  widely  at  variance  in  the  past,  and 
must  even  now  be  based  on  indirect  evidence.  There 
is  no  well-established  instance  of  human  infection  from 
the  use  of  the  flesh  of  tuberculous  cattle.  The  signifi- 
cance of  this  fact,  however,  is  diminished  by  the  observa- 
tion that  tubercle  bacilli  can  pass  through  the  intestinal 

^Lancet,  11  (1895),  46. 


52  FOOD  POISONING 

wall  without  leaving  any  trace  of  their  passage  and  can 
make  their  way  to  the  lungs  or  to  other  distant  organs 
where  they  find  opportunity  for  growth.  This,  together 
with  the  long  period  which  usually  elapses  between 
the  actual  occurrence  of  infection  and  the  discovery  of 
the  existence  of  infection,  makes  the  difficulty  of  securing 
valid  evidence  peculiarly  great.  Opposed  to  any  very 
frequent  occurrence  of  meat-borne  tuberculosis  are 
the  facts  that  the  tubercle  bacillus  is  not  commonly 
or  abundantly  present  in  the  masses  of  muscle  usually 
marketed  as  "meat,"  that  the  tubercle  germ  itself  is 
not  a  spore-bearer  and  is  killed  by  ordinary  cooking,  and 
that  the  reported  cases  of  the  finding  of  tubercle  bacilli 
of  bovine  origin  in  adults  over  sixteen  years  of  age  are 
extremely  rare.  This  latter  fact  is  perhaps  the  strongest 
evidence  indicating  that  tuberculous  meat  infection, 
although  theoretically  possible,  is  at  least  not  of  common 
occurrence. 

Most  of  the  commissions  and  official  agencies  that 
have  considered  the  precautions  to  be  taken  against 
possible  tuberculous  meat  infection  are  agreed  that  the 
entire  carcass  of  an  animal  should  be  condemned  when 
the  tuberculous  lesions  are  generalized  or  when  the 
lesions  are  extensive  in  one  or  both  body  cavities  as 
well  as  when  the  lesions  are  ''multiple,  acute,  and 
actively  progressive."  Any  organ  showing  evidence 
of  tuberculous  lesions  is  obviously  not  to  be  passed  as 
food.  On  the  other  hand,  it  is  considered  that  portions 
of  properly  inspected  animals  may  be  put  on  the  market 
if  the  tuberculous  lesion  is  local  and  limited  and  the  main 
part  of  the  body  is  unaffected;  in  such  cases  contamina- 
tion of  the  meat  in  dressing  must  be  avoided.     It  is  the 


FOOD-BORNE  PATHOGENIC  BACTERIA 


53 


general  belief  that  when  such  precautionary  measures 
are  taken  the  danger  of  tuberculous  infection  through 
properly  cooked  meat  is  so  slight  as  to  be  negligible. 

Milk  is  a  much  more  likely  vehicle  than  meat  for 
the  transmission  of  tuberculosis.  Freshly  drawn  raw 
milk  from  tuberculous  cattle  may  contain  enormous 
numbers  of  tubercle  bacilli,  especially  if  the  udder  is 
diseased.  Contamination  of  milk  by  the  manure  of 
tuberculous  cows  can  also  occur.  Observers  in  England, 
Germany,  France,  and  the  United  States  have  found 
tubercle  bacilli  in  varying  numbers  in  market  milk, 
and  have  proved  that  such  milk  is  infectious  for  labora- 
tory animals.  Although,  as  pointed  out  with  reference 
to  meat  infection,  the  difficulties  of  tracing  any  partic- 
ular case  of  tuberculosis  to  its  source  are  very  great, 
there  are  a  number  of  instances  on  record  in  which  the 
circumstantial  evidence  strongly  indicates  that  milk 
was  the  vehicle  of  infection.  Especially  convincing 
are  the  observations  on  the  relative  frequency  of  infection 
with  bovine  and  human  tubercle  bacilli  at  different 
ages  as  shown  in  the  following  tabulation:' 


Adults  Sixteen 
Years  Old 
and  Over 


Children  Five  to 

Sixteen  Years 

Old 


Children  under 
Five  Years 


Human  tubercle  bacilli  found 
Bovine  tubercle  bacilli  found 


677 
9 


9Q 
33 


161 
59 


The  large  proportion  of  bovine  tubercle  bacillus 
infections  in  children  stands  in  all  probability  in  causal 
relation  to  the  relatively  extensive  use  of  raw  milk 
in  the  child's  dietary. 

'  Park  and  Krumwiede,  Jour.  Med.  Research,  N.S.,  XV'III 
(1910),  363, 


54  FOOD  POISONING 

The  proper  pasteurization  of  milk  affords  a  safe  and 
reasonably  satisfactory  means  of  preventing  tuberculous 
infection  from  this  source.  The  general  introduction 
of  the  pasteurizing  process  in  most  American  cities  has 
ample  justification  from  the  standpoint  of  the  prevention 
of  infection. 

•VARIOUS   MILK-BORNE   INFECTIONS 

The  facts  related  in  the  foregoing  pages  indicate 
that  of  all  foods  milk  is  the  most  likely  to  convey 
disease  germs  into  the  human  body.  This  is  partly 
due  to  the  fact  that  milk  is  sometimes  obtained  from 
diseased  animals,  and  partly  to  the  fact  that  unless 
great  care  is  taken  it  may  readily  become  contaminated 
during  the  process  of  collection  and  transportation;  if 
milk  is  once  seeded  with  dangerous  bacteria  these  can 
multiply  in  the  excellent  culture  medium  it  affords. 
It  is  also  partly  because  milk  is  commonly  taken  into 
the  alimentary  tract  without  being  cooked.  For  these 
reasons  the  amount  of  illness  traceable  to  raw  milk 
far  exceeds  that  ascribable  to  any  other  food. 

There  are  several  infections  that  may  be  com- 
municated by  milk,  but  are  rarely  if  ever  due  to  other 
foodstuffs.  Diphtheria  and  scarlet  fever  are  perhaps 
the  best  known  of  these.  Both  diseases  have  been 
repeatedly  traced  to  the  use  of  particular  milk  supplies, 
although  various  forms  of  individual  contact  also  play 
a  large  role  in  their  dissemination.  Milk-borne  scarlet 
fever  and  diphtheria  seem  to  be  generally,  if  not  always, 
due  to  the  direct  contamination  of  the  milk  from  human 
sources.  It  is  considered  possible,  however,  by  some 
investigators    that    the    cow    may    sometimes    become 


FOOD-BORNE  PATHOGENIC  BACTERIA  55 

infected  from  human  sources  with  the  virus  of  scarlet 
fever  or  diphtheria  and  may  herself  occasionally  con- 
tribute directly  to  the  infection  of  the  milk. 

A  serious  milk-borne  disease,  which  has  lately  been 
conspicuous  in  Boston,  Chicago,  Baltimore,  and  other 
American  cities  under  the  name  of  "septic  sore  throat" 
or  "streptococcus  sore  throat,"  originates  apparently  in 
some  cases  from  infection  of  the  udder  of  the  cow  by  an 
infected  milker;  in  other  cases  the  milk  has  seemingly 
been  directly  infected  by  a  human  "carrier."  The 
specific  germ  is  thought  to  have  been  isolated  and  its 
connection  with  the  disease  demonstrated  in  the  lab- 
oratory. This  disease,  like  diphtheria  and  scarlet  fever, 
is  sometimes  due  to  contact.  It  is  not  known  to  be 
caused  by  any  food  except  milk. 

Foot-and-mouth  disease  of  cattle  is  transmissible  to 
man  through  the  milk  of  infected  cattle,  but  this  infec- 
tion in  man  is  not  very  common  or  as  a  rule  very  serious. 
So  far  as  known,  it  is  not  communicated  to  man  in  any 
other  way  except  through  the  use  of  uncooked  milk. 

Such  cases  of  infection  or  "poisoning"  by  milk  may 
be  prevented,  as  already  stated,  by  the  exclusive  \\se 
of  heated  milk.  The  possible  occurrence  of  nutritional 
disturbances  (e.g.,  scurvy)  in  a  small  proportion  of  the 
children  fed  on  pasteurized  or  boiled  milk  is  considered 
by  many  physicians  to  be  easily  remedied  and  to  possess 
much  less  practical  importance  than  the  avoidance  of 
infection. 

POSSIBLE   INFECTION   WITH   B.    PROTEUS 

One  widely  distributed  organism  known  as  Bacillus 
Proteus  has  been  several  times  held  responsible  for  food 


56  FOOD  POISONING 

poisoning  outbreaks,  but  it  is  not  yet  certain  how  far 
this  accusation  is  justified.  B.  proteus  is  related  to 
B.  coli,  but  most  varieties  do  not  ferment  lactose  and 
are  much  more  actively  proteolytic  than  the  latter 
organism,  as  shown  by  their  ability  to  liquefy  gelatin 
and  casein.  Like  B.  coli,  they  form  indol  and  ferment 
dextrose  with  gas  production.  Varieties  of  B.  proteus 
are  found  widely  distributed  in  decomposing  organic 
matter  of  all  sorts. 

The  evidence  upon  which  this  bacillus  is  regarded  as 
the  cause  of  food  poisoning  is  not  altogether  convincing. 
The  outbreak  described  by  Pfuhl'  is  topical.  Eighty- 
one  soldiers  in  a  garrison  at  Hanover  were  suddenly 
attacked  with  acute  gastro-enteritis  four  to  twelve 
hours  after  eating  sausage  meat.  The  meat  was  found 
to  contain  B.  proteus  in  large  numbers,  although  it  was 
prepared  with  ordinary  care  and  was  entirely  normal  in 
appearance,  taste,  and  smell.  Rats  and  mice  fed  with 
the  sausage  became  ill  and  B.  proteus  was  isolated  from 
the  blood  and  internal  organs.  But  these  animals 
sometimes  die  when  fed  with  quite  normal  meat,  and 
B.  proteus  and  other  common  intestinal  bacteria  are 
often  isolated  from  the  body  after  death.  B.  proteus, 
in  fact,  is  found  in  many  animal  foods  and  in  the  appar- 
ently normal  human  intestine.  Like  B.  coli,  it  fre- 
quently invades  the  internal  organs  after  or  shortly 
before  death.  Finding  B.  proteus  in  food  or  in  the 
internal  organs  does  not  therefore  constitute  definite 
proof  of  any  causal  relationship.  The  evidence  attribut- 
ing other  outbreaks  to  infection  with  B.  proteus  is 
similarly  inconclusive. 

'  Zlschr.  f.  Hyg.,  XXXV  (1900),  265. 


FOOD-BORNE  PATHOGENIC  BAC^TERIA  57 

It  is  cfiually  uncertain  whether  tlie  production  of  a 
poison  in  food  by  this  species  can  in  any  degree  be  held 
responsible  for  meat  poisoning.  B.  proleus  is  common 
enough  in  decomposing  food  material  and  under  cer- 
tain circumstances  is  known  to  generate  substances  that 
are  toxic  for  man.  It  is  possibly  true  that  toxic  sub- 
stances are  produced  in  the  early  stages  of  decom- 
position by  this  organism.  In  the  opinion  of  MandeP 
and  others,  if  any  injurious  effect  at  all  is  to  be 
attributed  to  B.  proteus,  it  is  in  the  nature  of  an  intoxica- 
tion and  not  an  infection  (see  chapter  viii).  So  far  as 
the  existing  evidence  goes,  the  question  of  the  respon- 
sibility of  this  organism  for  food  poisoning  is  still  an 
open  one. 

'  Ceutralbl.f.  BakL,  I,  Orig.,  LXVI  (191 2),  194. 


CHAPTER  VI 

FOOD-BORNE  PATHOGENIC  BACTERIA  {Continued) 

PARATYPHOID   INFECTION 

The  most  characteristic  examples  of  "food  poisoning," 
popularly  speaking,  are  those  in  which  the  symptoms 
appear  shortly  after  eating  and  in  which  gastro- 
intestinal disturbances  predominate.  In  the  typical 
group-outbreaks  of  this  sort  all  grades  of  severity  are 
manifested,  but  as  a  rule  recovery  takes  place.  The 
great  majority  of  such  cases  that  have  been  investigated 
by  modern  bacteriological  methods  show  the  presence 
of  bacilli  belonging  to  the  so-called  paratyphoid  group 
{B.  paraiyphosus  or  B.  enteritidis).  Especially  is  it 
true  of  meat  poisoning  epidemics  that  paratyphoid 
bacilli  are  found  in  causal  relation  with  them.  Hiibener^ 
enumerates  forty-two  meat  poisoning  outbreaks  in 
Germany  in  which  bacilli  of  this  group  were  shown  to 
be  implicated,  and  Savage^  gives  a  list  of  twenty-seven 
similar  outbreaks  in  Great  Britain.  In  the  United 
States  relatively  few  outbreaks  of  this  character  have 
been  placed  on  record,  but  it  cannot  be  assumed  that 
this  is  due  to  their  rarity,  since  no  adequate  investiga- 
tion of  food  poisoning  cases  is  generally  carried  out  in 
our  American  communities. 

Typical  paratyphoid  outbreaks. — Kaensche^  describes 
an  outbreak  at  Breslau  involving  over  eighty  persons 

'  Fleischvergiflnngen  it.  Paralyphusinfeklioncn  (Jena,  19 lo). 
^  Rcpt.  to  Local  Govt.  Board,  N.S.  No.  77  (London,  1913). 
3Z«7./.i/^g.,  XXII  (1896),  53. 
58 


FOOD-BORNE  PATHOGENIC  BACTERIA  59 

in  which  chopped  beef  was  apparently  the  bearer  of 
infection.  The  animal  from  which  the  meat  came  had 
been  ill  with  severe  diarrhea  and  high  fever  and  was 
slaughtered  as  an  emergency  measure  {nolgeschlachtet) . 
On  examination  a  pathological  condition  of  the  liver 
and  other  organs  was  noted  by  a  veterinarian  who 
declared  the  meat  untit  for  use  and  ordered  it  destroyed. 
It  was,  however,  stolen,  carried  secretly  to  Breslau,  and 
portions  of  it  were  distributed  to  different  sausage- 
makers,  who  sold  it  for  the  most  part  as  hamburger 
steak  (Hackjlcisch).  The  meat  itself  presented  nothing 
abnormal  in  color,  odor,  or  consistency.  Nevertheless, 
illness  followed  in  some  cases  after  the  use  of  very  small 
portions.  With  some  of  those  affected  the  s^miptoms 
were  very  severe,  but  there  were  no  deaths.  Bacilli  of 
the  Bacillus  enieritidis  type  were  isolated  from  the  meat. 

A  large  and  unusually  severe  outbreak  reported  by 
McWeeney'  occurred  in  November,  1908,  among  the 
inmates  of  an  industrial  school  for  girls  at  Limerick, 
Ireland.  There  were  73  cases  with  9  deaths  out  of  the 
total  number  of  197  pupils.  The  brunt  of  the  attack 
fell  on  the  first  or  Senior  class  comprising  67  girls 
between  the  ages  of  thirteen  and  seventeen.  Out  of 
55  girls  belonging  to  this  class  who  partook  of  beef  stew 
for  dinner  53  sickened,  and  8  of  these  died.  One  of  the 
two  who  were  not  aft'ected  ate  the  gravy  and  potatoes 
but  not  the  beef.  Some  of  the  implicated  beef  was 
also  eaten  as  cold  meat  by  girls  in  some  of  the  other 
classes,  and  also  caused  illness.  Part  of  the  meat  had 
been  eaten  previously  without  producing  any  ill  effects. 
"The  escape  of  those  who  partook  of  portions  of  the 

'  BrU.  Med.  Jour.,  I  (1909),  1171. 


6o  FOOD  POISONING 

same  carcass  on  October  27  and  29  [five  days  earlier] 
may  be  accounted  for  either  by  unequal  distribution  of 
the  virus,  or  by  thorough  cooking  which  destroyed  it. 
Some  of  the  infective  material  must,  however,  have 
escaped  the  roasting  of  the  29th,  and,  multiplying 
rapidly,  have  rendered  the  whole  piece  intensely  toxic 
and  infective  during  the  five  days  that  elapsed  before 
the  fatal  Tuesday  when  it  was  finally  consumed." 
The  animal  from  which  the  fore  quarter  of  the  beef  was 
taken  had  been  privately  slaughtered  by  a  local  butcher. 
No  reliable  information  could  be  obtained  about  the 
condition  of  the  calf  at,  or  slightly  prior  to,  slaughter. 
The  meat,  however,  was  sold  at  so  low  a  price  that  it  was 
evidently  not  regarded  as  of  prime  quality.  In  this 
outbreak  the  agglutination  reactions  of  the  blood  of  the 
patients  and  the  characteristics  of  the  bacilli  isolated 
showed  the  infection  to  be  due  to  a  typical  strain  of 
Bacillus  enter itidis. 

An  epidemic  of  food  poisoning  occurred  in  July,  19 15, 
at  and  near  Westerly,  Rhode  Island.^  The  outbreak 
was  characterized  by  the  usual  symptoms  of  acute 
gastro-enteritis,  and  followed  the  eating  of  pie  which 
was  obtained  at  a  restaurant  in  Westerly.  All  the 
circumstances  of  the  outbreak  showed  that  a  particular 
batch  of  pies  was  responsible.  About  sixty  persons 
were  made  seriously  ill  and  four  died.  There  was  no 
unusual  taste  or  odor  to  the  pies  to  excite  suspicion. 
The  symptoms  followed  the  eating  of  various  kinds  of 
pie:  custard,  squash,  lemon,  chocolate,  apple,  etc., 
that  had  been  made  with  the  same  pie-crust  mixture. 
Bacillus  paratypJiosus  B  was  isolated  from  samples  of 

'  Bernstein  and  Fish,  Jour.  Ainer.  Med.  Assoc,  LXVI  (1916),  167. 


FOOD-BORNE  PATHOGENIC  BACTERIA  6i 

pic  that  were  examined.  No  definite  clue  was  obtained 
as  to  the  exact  source  of  infection  of  the  pie  mixture. 
It  is  possible  that  the  pie  became  infected  in  the  res- 
taurant through  the  agency  of  a  paratyphoid-carrier, 
but  since  there  had  been  no  change  in  the  personnel  of 
the  restaurant  for  several  months,  this  explanation  is 
largely  conjectural.  Possibly  some  ingredient  of  animal 
origin  was  primarily  infected. 

General  characters  of  paratyphoid  infection. — ^The 
symptoms  of  paratyphoid  food  infection  are  varied. 
As  a  rule  the  first  signs  of  trouble  appear  within  six 
to  twelve  hours  after  eating,  but  sometimes  they  may 
come  on  within  half  an  hour,  or  they  may  not  appear 
until  after  twenty-four  to  forty-eight  hours.  Gastro- 
intestinal irritation  is  practically  always  present,  and 
may  take  the  form  of  a  mild  "indigestion"  or  slight 
diarrhea  or  may  be  of  great  severity  accompanied  with 
agonizing  abdommal  pain.  Fever  is  usual,  but  is 
generally  not  very  high.  Recovery  may  occur  quickly, 
so  that  within  two  or  three  days  the  patient  regains  his 
normal  state,  or  it  may  be  very  slow,  so  that  the  effects 
of  the  attack  linger  for  weeks  or  months. 

Investigators  have  noted  the  occurrence  of  at  least 
two  clinical  types  of  paratyphoid  infection,  the  com- 
moner gastro-intestinal  type  just  described  and  a  second 
type  resembling  typhoid  fever  very  closely,  and  occa- 
sionally not  to  be  distinguished  from  it  except  by  careful 
bacterial  examination.  It  is  not  yet  clear  how  these  two 
clinical  varieties  are  related  to  the  amount  and  nature 
of  the  infecting  food  material.  No  difference  in  the 
type  of  paratyphoid  bacillus  has  been  observed  to  be 
associated  with  the  diff'erence  in  clinical  manifestation. 


62  FOOD  POISONING 

Possibly  the  amount  of  toxin  present  in  the  food  eaten 
as  well  as  the  number  of  bacilli  may  exercise  some 
influence.  The  individual  idiosyncrasy  of  the  patient 
doubtless  plays  a  part. 

While  there  is  still  some  uncertainty  about  particular 
features  of  paratyphoid  infection,  a  few  significant  facts 
have  been  clearly  established:  (i)  Certain  articles  of 
diet  are  much  more  commonly  associated  than  others 
with  this  type  of  food  poisoning.  The  majority  of 
recorded  outbreaks  are  connected  with  the  use  of  meat, 
milk,  fish,  and  other  protein  foods.  Vegetables  and 
cereals  have  been  less  commonly  implicated,  fruits 
rarely.  (2)  In  many,  though  not  all,  of  the  cases  of 
parat>^hoid  meat  poisoning  it  has  been  demonstrated 
that  the  meat  concerned  has  been  derived  from  an 
animal  slaughtered  while  ailing  {notgeschlachtet,  to  use 
the  expressive  German  term).  There  seems  reason 
to  believe  that  in  such  an  animal,  ''killed  to  save  its 
life,"  the  specific  paratyphoid  germ  is  present  as  an 
infection  before  death.  Milk  also  has  caused  para- 
typhoid poisoning  and  in  certain  of  these  cases  has  been 
found  to  be  derived  from  a  cow  suffering  from  enteritis 
or  some  other  disorder.  (3)  There  is  evidence  that 
originally  wholesome  food  may  become  infected  with 
paratyphoid  bacilli  during  the  process  of  preparation  or 
serving  in  precisely  the  same  way  that  it  may  become 
infected  with  t>^hoid  bacilli;  the  handling  of  the  food 
by  a  paratyphoid-carrier  is  commonly  responsible  for 
this.  In  a  few  instances  the  disease  is  passed  on  from 
case  to  case,  but  this  mode  of  infection  seems  exceedingly 
rare  and  is  not  nearly  so  frequent  as  "contact"  infection 
in  typhoid.     (4)  The  majority  of  parat>^hoid  outbreaks 


FOOD-BORNE  PATHOGENIC  BACTERIA  63 

are  associated  with  the  use  of  uncooked  or  partly  cooked 
food.  A  selective  action  is  often  manifested,  those 
persons  who  have  eaten  the  incriminated  food  substance 
raw  or  imperfectly  cooked  being  most  seriously  affected, 
while  those  who  have  partaken  of  the  same  food  after 
cooking  remain  exempt. 

The  discovery  of  the  •'*  «*'x^"^"^*k^ 

connection   of    paraty-  ^<  m*''^^'^  *^       *»4 

phoid  baciUi  with  meat  ,\  v'  j  ^  V^^  '  v  * 
poisoning  dates  from  /^^  '"^''^\''"  ^  '  iJL,**Ji  " 
the  investigation  by  *  -  i*-*-*^.  -  Jt  i\  v# 
Gartner,^  in  1888,  of  a 
meat  poisoning  out- 
break  in    Frankenhau- 

sen,   a    small    town   in  ,         -^  ^     ^       , 

Germany.     This  epi-  V     *J^^V. 

demic  was  traced  to  the  ^  **" 

use  of  meat  from  a  cow  ^^^-  ^--Bacillus  enkritidis,  Gartner; 

,  111     pure  culture;  Van  Ermengem  prepara- 

that     was     slaughtered    ^j^^      (Kolle  and  Wassermann.) 

because  she  was  ill  with 

a  severe  enteritis.  Fifty-eight  persons  were  affected  in 
varying  grades  of  severity;  the  attack  resulted  fatally  in 
one  young  workman  who  ate  about  eight  hundred  grams 
of  raw  meat.  Gartner  isolated  from  the  spleen  of  the 
fatal  case  and  also  from  the  flesh  and  intestines  of  the 
cow  a  bacillus  to  which  he  gave  the  name  B.  enteritidis. 
Inoculation  experiments  showed  it  to  be  pathogenic 
for  a  number  of  animal  species.  Bacilli  with  similar 
characters  have  since  been  isolated  in  a  number  of 
other  meat  poisoning  epidemics  in  Germany,  Belgium, 
France,   and   England.     One   well-studied   instance   of 

■  Breslau  aerztl.  Ztschr.,  X  (1888),  249. 


64  FOOD  POISONING 

food  poisoning  due  to  the  paratyphoid  bacillus  has 
been  reported  in  the  United  States.' 

The  bacteria  of  the  paratyphoid  group  are  closely 
related  to  the  true  typhoid  bacillus,  but  differ  from  the 
latter  organism  in  being  able  to  ferment  glucose  with 
gas  production.  They  are  more  highly  pathogenic  for 
the  lower  animals  than  is  the  typhoid  bacillus,  but 
apparently  somewhat  less  pathogenic  for  man.  Most 
types  of  paratyphoid  bacilli  found  in  food  poisoning 
produce  more  or  less  rapidly  a  considerable  amount  of 
alkali,  and,  if  they  are  inoculated  into  milk  containing 
a  few  drops  of  litmus,  the  milk  after  a  time  becomes 
a  deep  blue  color.  Several  distinct  varieties  of  para- 
typhoid bacilli  have  been  discovered.  The  main 
differences  shown  by  these  varieties  are  agglutinative 
differences.  That  is,  the  blood  serum  of  an  animal  that 
has  been  inoculated  with  a  particular  culture  or  strain 
will  agglutinate  that  strain  and  also  other  strains  isolated 
from  certain  other  meat  poisoning  epidemics,  but  will 
not  agglutinate  certain  culturally  similar  paratyphoid 
bacteria  found  in  connection  with  yet  other  outbreaks. 
Except  in  this  single  matter  of  agglutination  reaction, 
no  constant  distinction  between  these  varieties  has  been 
demonstrated.  The  clinical  features  of  the  infections 
produced  in  man  and  in  the  higher  animals  by  the  dif- 
ferent varieties  seem  to  be  very  similar  if  not  identical. 

The  bacillus  discovered  by  Gartner  {loc.  cit.)  and 
known  as  B.  enteritidis  or  Gartner's  bacillus  is  commonly 
taken  as  the  type  of  one  of  the  agglutinative  varieties. 
Bacilli  with  all  the  characters  of  Gartner's  bacillus  have 
been   found   in   meat  poisoning   epidemics   in   various 

•  Bernstein  and  Fish,  Jojir.  Amcr.  Med.  Assoc,  LXVI  (1916),  167. 


FOOD-BORNE  PATHOGENIC  BACTERIA  65 

places  in  Belgium  and  Gcniian\'.  Mayer'  has  compiled 
a  list  of  forty-eight  food  poisoning  outbreaks  occurring 
between  1888  and  1911  and  attributed  to  B.  enlerilidis 
Gartner.  These  outbreaks  comprised  approximately  two 
thousand  cases  and  twenty  deaths.  In  twenty-three 
of  the  forty-eight  outbreaks  the  meat  was  derived  from 
animals  known  to  be  ill  at  the  time,  or  shortly  before, 
they  were  slaughtered.  Sausage  and  chopped  meat  of 
undetermined  origin  were  responsible  for  eleven  of  the 
remaining  twenty-five  outbreaks.  Two  of  the  B.  enter- 
///(/i5  outbreaks  were  attributed  to  Vanille  Pudding;  one, 
to  potato  salad. 

In  other  food  poisoning  outbreaks  a  bacillus  is  found 
which  is  culturally  similar  to  the  Gartner  bacillus,  but 
refuses  to  agglutinate  with  the  Gartner  bacillus  serum. 
Its  cultural  and  agglutination  reactions  are  almost,  if 
not  quite,  identical  with  those  of  the  bacilli  found  in 
human  cases  of  paratyphoid  fever  which  have  no  known 
connection  with  food  poisoning.  Mayer^  gives  a  list  of 
seventy-seven  outbreaks  of  food  poisoning  (1893-1911) 
in  which  organisms  variously  designated  as  ^'B.  para- 
typhosus  B"  or  as  ^'^B.  suipestifer''  were  held  to  be 
responsible.  The  total  number  of  cases  (two  thousand) 
and  deaths  (twenty)  is  about  the  same  as  ascribed  to 
B.  enleritidis.  According  to  Mayer's  tabulation  meat 
from  animals  definitely  known  to  be  ailing  is  less  com- 
monly implicated  in  this  type  (ten  in  seventy-seven) 
than  in  B.  enterilidis  outbreaks  (twenty-three  in  forty- 
eight).  Sausage  and  chopped  meat  of  unknown  origin, 
however,  were  connected  with  eighteen  outbreaks. 

^Deutsche  Viertelj.f.  offenlL  Ges.,  XLV  (1913),  58-59. 
^Op.  cit.,  pp.  60-62. 


66  FOOD  POISONING 

The  bacillus  named  B.  suipestifer  was  formerly 
believed  to  be  the  cause  of  hog  cholera,  but  it  is  now 
thought  to  be  merely  a  secondary  invader  in  this  disease ; 
it  is  identical  with  the  bacillus  called  B.  paratypho- 
sus  B  in  its  cultural  and  to  a  large  extent  in  its  agglutina- 
tive behavior,  but  is  regarded  by  some  investigators  as 
separable  from  the  latter  on  the  basis  of  particularly 
delicate  discriminatory  tests.  Bainbridge,  Savage,  and 
other  English  investigators  consider  indeed  that  the 
true  food  poisoning  cases  should  be  ascribed  to  B.  sui- 
pestifer and  would  restrict  the  term  B.  paratyphosus 
to  those  bacteria  causing  *'an  illness  clinically  indistin- 
guishable from  typhoid  fever."  German  investigators, 
on  the  other  hand,  regard  B.  suipestifer  and  B.  para- 
typhosus B  as  identical.  My  own  investigations*  indicate 
that  there  is  a  real  distinction  between  these  two  types. 

Bearing  directly  on  this  question  is  the  discussion 
concerning  the  distribution  of  the  food  poisoning  bacilli 
in  nature.  Most  investigators  in  Germany,  where  the 
majority  of  food  poisoning  outbreaks  have  occurred, 
or  at  least  have  been  bacteriologically  studied,  are  of 
the  opinion  that  B.  suipestifer  (the  same  in  their  opinion 
as  B.  paratyphosus  B)  is  much  more  widely  distributed 
than  B.  enteritidis  and  that  it  occurs,  especially  in  certain 
regions,  as  in  the  southern  part  of  the  German  Empire, 
quite  commonly  in  the  intestinal  tract  of  healthy  human 
beings.  Such  paratyphoid-carriers,  it  is  supposed,  may 
contaminate  food  through  handling  or  preparation 
just  as  typhoid-carriers  are  known  to  do.  A  number 
of  outbreaks  in  which  contamination  of  food  during 
preparation   is   thought   to   have   occurred   have   been 

^  Jour.  Infect.  Dis.,  XX  (1917),  457. 


FOOD-BORNE  PATHOGENIC  BACTERIA  67 

reported  by  Jacobitz  and  Kayser'  (vermicelli),  Reinhold- 
(fish),  and  others.  Reinhold  notes  that  in  one  outbreak 
several  persons  who  had  nursed  those  who  were  ill 
became  ill  themselves,  indicating  possible  contact 
infection.  In  another  outbreak  also  reported  by  Rein- 
hold  it  was  observed  that  those  who  partook  of  the 
infected  food,  in  this  case  dried  codfish,  on  the  first 
day  were  not  so  severely  affected  as  those  who  ate  what 
was  left  over  on  the  second  day.  A  bacillus  belonging 
to  the  paratyphoid  group  was  isolated  from  the  stools 
of  patients,  but  not  from  the  dried  codfish.  These 
facts  were  interpreted  as  signifying  that  the  fish  had 
become  infected  in  the  process  of  preparation  and  that 
the  bacilli  multiplied  in  the  food  while  it  was  standing. 
There  seems  no  doubt  that  certain  cases  of  paraty- 
phoid food  poisoning  are  caused  by  contamination  of 
the  food  during  preparation  and  are,  sometimes  at 
least,  due  to  infection  by  human  carriers.  The  bacilli 
in  such  cases  are  usually  (according  to  many  German 
investigators)  or  always  (according  to  most  English 
bacteriologists)  of  the  B.  suipestifer  type.  Other  cases 
are  due  to  pathogenic  bacteria  derived  from  diseased 
animals,  and  these  bacteria  are  often,  possibly  always, 
of  a  slightly  different  character  (B.  enteritidis  Gartner). 
It  is  still  unsettled  whether  both  types  of  food  poisoning 
bacteria  are  always  associated  with  disease  processes 
of  man  or  animals,  or  whether  they  are  organisms  of 
wide  distribution  which  may  at  times  acquire  pathogenic 
properties.  In  certain  regions,  as  in  North  Germany 
and  England,  such  bacteria  are  rarely,  if  ever,  found 

^  Centralbl.  f.  Bakl.,  I  Orig.,  LIII  (1910),  377. 
^Cor.-Bl.f.  schweiz.  Aerzte,  XLII  (1912),  2S1  and  332. 


68  FOOD  POISONING 

except  in  connection  with  delinite  cases  of  disease. 
In  parts  of  Southwest  Germany,  on  the  other  hand,  they 
are  said  to  occur  with  extraordinary  frequency  in  the 
intestines  of  healthy  men  and  animals.  Savage'  believes 
that  there  is  some  confusion  on  this  subject  owing  to  the 
existence  of  saprophytic  bacteria  which  he  calls  "Para- 
gaertner"  forms  and  which  bear  a  close  resemblance 
to  the  "true"  Gartner  bacilli.  They  can  be  distin- 
guished from  the  latter  only  by  an  extended  series  of 
tests.  The  bacilli  of  this  group  show  remarkable 
variability,  and  in  the  opinion  of  some  investigators 
"mutations"  sometimes  occur  which  lead  to  the  trans- 
formation of  one  type  into  another.^ 

In  spite  of  the  present  uncertainty  regarding  the 
relationship  and  significance  of  the  varieties  observed, 
a  few  facts  emerge  plainly  from  the  confusion:  (i)  The 
majority  of  meat  poisoning  outbreaks  that  have  been 
bacterially  studied  in  recent  years  have  been  traceable 
to  one  or  another  member  of  this  group  and  not  to 
"ptomain  poisoning."  (2)  Bacteria  of  the  paratyphoid 
cnteritidis  group  that  are  culturally  alike  but  agglutina- 
tively  dissimilar  can,  when  taken  in  with  the  food,  give  rise 
to  identical  clinical  symptoms  in  man.  (3)  Food  poison- 
ing bacteria  of  this  group,  when  derived  directly  from 
diseased  animals,  seem  more  likely  to  be  of  the  Gartner 
type  {B.  enteritidis)  than  of  the  B.  suipestifer  type. 

Toxin  production. — The  problem  of  the  production 
of  toxin  by  the  bacteria  of  this  group  and  the  possible 
relation  of  the  toxin  to  food  poisoning  has  been  much 

^  Jour.  Hyg.,  XII  (1912),  i. 

^  Sec  Sobernheim  and  Scligmann,  Cciilralbl.  f.  Bakl.,  Rcf.,  Bcilage, 
L  (1911),  134. 


FOOD-BORNE  PATHOGENIC  BACTERIA  69 

discussed.  Broth  cultures  in  which  the  hving  bacilH 
have  been  destroyed  by  heat  or  from  which  they  have 
been  removed  by  filtration  contain  a  soluble  poison. 
When  this  germ-free  broth  is  injected  into  mice, 
guinea-pigs,  or  rabbits,  the  animals  die  from  the  effects. 
Practically  nothing  is  known  about  the  nature  of  the 
poisonous  substances  concerned,  except  that  they  are 
heat-resistant.  They  are  probably  not  to  be  classed  with 
the  so-called  true  toxins  generated  by  the  diphtheria 
and  tetanus  bacilli,  since  there  is  no  evidence  that  they 
give  rise  to  antibodies  when  injected  into  susceptible 
animals.  In  the  opinion  of  some  investigators  the 
formation  of  these  toxic  bodies  by  the  paralyphoid- 
enteritidis  bacilli  in  meat  and  other  protein  foodstuffs 
is  responsible  for  certain  outbreaks  and  also  for  some 
of  the  phenomena  of  food  poisoning,  the  rapid  develop- 
ment of  symptoms  being  regarded  as  due  to  the  ingested 
poisons,  whereas  the  later  manifestations  are  considered 
those  of  a  true  infection.  Opposed  to  this  view  is  the  fact 
that  well-cooked  food  has  proved  distinctly  less  liable  to 
cause  food  poisoning  than  raw  or  imperfectly  cooked  food. 
A  large  proportion  of  the  recorded  meat  poisoning 
outbreaks  are  significantly  due  to  sausages  made  from 
raw  meat  and  to  meat  pies,  puddings,  and  jellies.  This 
is  most  likely  because  the  heat  used  in  cooking  such 
foods  is  insufiicient  to  produce  germicidal  results.  In 
milk-borne  epidemics  also  it  is  noteworthy  that  the  users 
of  raw  milk  are  the  ones  affected.  For  example,  respect- 
ing an  extensive  B.  enteritidls  outbreak  in  and  about 
Newcastle,  England,  it  is  stated: 

In  no  instance  was  a  person  who  had  used  only  boiled  milk 
known  to  have  been  affected.     Thus  in  one  family,  consisting  of 


70  FOOD  POISONING 

husband,  wife,  and  wife's  mother,  the  two  women  drank  a  small 
quantity  of  raw  milk  from  the  farm,  at  the  most  a  tumblerful, 
and  both  were  taken  ill  about  twelve  hours  later.  The  husband, 
on  the  other  hand,  habitually  drank  a  pint  a  day,  but  always 
boiled.  He  followed  his  usual  custom  on  this  occasion,  and  was 
unaffected.' 

When  in  addition  it  is  taken  into  consideration  that 
the  ordinary  roasting  or  broihng  of  a  piece  of  meat  is 
often  not  sufficient  to  produce  a  germicidal  temperature 
throughout,  the  argument  that  a  heat-resistant  toxin 
is  present  in  such  cases  is  not  conclusive.  It  must  be 
remembered  also  that  in  some  outbreaks  those  persons 
consuming  raw  or  partly  cooked  meat  have  been  affected 
while  at  the  same  time  others  eating  well-cooked  meat 
from  the  same  animal  have  remained  exempt;  this 
would  seem  to  indicate  the  destruction  of  living  bacilli 
by  heat,  since  the  toxic  substances  formed  by  these 
organisms  are  heat-resistant.  The  view  that  a  definite 
infection  occurs,  is  favored,  too,  by  the  fact  that  the 
blood-serum  of  affected  persons  so  frequently  has  an 
agglutinative  action  upon  the  paratyphoid  bacillus. 
This  would  not  be  the  case  if  the  symptoms  were  due 
to  toxic  substances  alone.  Altogether  the  role  of  toxins 
formed  by  B.  enteritidis  and  its  allies  in  food  outside 
the  body  cannot  be  said  to  be  established.  The  avail- 
able evidence  points  to  infection  as  the  main,  if  not  the 
sole,  way  in  which  the  bacilli  of  this  group  are  harmful. 

Sources  of  injection. — The  main  sources  of  enteritidis- 
suipestifer  infection  are:  (i)  diseased  domestic  animals, 
the  infected  flesh  or  milk  of  which  is  used  for  food; 
(2)  infection  of  food  by  human  carriers  during  the  process 

'  Report  Med.  Officer  of  Heallh  (Newcastle-upon-Tyne,  19 13). 


FOOD-BORNE  PATHOGENIC  BACTERIA 


71 


of  preparation  or  serving.  To  these  may  be  added  a 
third  possibility:  (3)  contamination  of  food  with  bacteria 
of  this  group  which  arc  inhabitants  of  the  normal  animal 
intestine.     Considering  these  in  order: 

I.  Diseased  animals:  The  majority  of  the  meat 
poisoning  outbreaks  are  caused  by  meat  derived  from 
pigs  or  cattle.  Table  III  gives  the  figures  for  a  number 
of  British'  and  German^  epidemics. 

TABLE  III* 


Belonging  to 

B. 

:>}TERITIDIS 

B.  SUIPESTIFER 

This  Group  but 
Undifferen- 

tiated 

British 

German 

Total 

British 

German 

Total 

British 

Pig 

I 

I 

2 

3 

5 

8 

4 

Ox  or  cow  . . 

3 

9 

12 

2 

3 

5 

5 

Calf 

0 

7 

7 

2 

4 

0 

Korse 

0 

I 

I 
0 

I 

I 

0 
0 

I 
I 

1 
I 

Chickens  .  . . 

*  It  must  be  noted  that  origin  of  the  food  from  a  diseased  animal  was  not  definitely 
proved  in  all  the  cases  cited.  Some  of  these  cases  should  possibly  be  classed  under 
human  contamination  (2). 

Occasional  outbreaks  have  also  been  attributed  to  in- 
fection through  eating  rabbit,  sheep,  goose,  fish,  shrimp, 
and  oysters.  Especially  noteworthy  is  the  relative 
rarity  of  infection  from  the  meat  of  the  sheep. 

More  definite  information  is  needed  respecting  the 
pathological  conditions  caused  by  these  bacteria  in 
animals  and  the  relation  of  such  conditions  to  sub- 
sequent human  mfection.  A  rather  remarkable  problem 
is  presented  by  the  relation  of  B.  suipestifer  to  hog 
cholera.     This  bacillus,   although  not  now  considered 

'  Compiled  from  Savage,  Report  of  Local  Gov't  Board,  1913. 

*  Mayer,  Deutsche  Viertelj.f.  djjentl.  Gcs.,  XLV  (1913),  8. 


72  FOOD  POISONING 

the  causal  agent  of  hog  cholera,  is  very  commonly 
associated  with  the  disease  as  an  accessory  or  secondary 
invader,  and  is  frequently  found  in  the  internal  organs 
of  swine  after  death.  It  might  be  supposed  that  in 
regions  where  hog  cholera  is  prevalent  human  infections 
would  be  more  common  than  in  other  districts,  but  this 
seems  not  to  be  the  case.  No  connection  has  ever 
been  demonstrated  between  outbreaks  of  hog  cholera — 
in  which  B.  suipestifer  is  known  to  be  abundantly 
distributed — and  so-called  B.  suipestifer  infections  in 
man. 

Suppurative  processes  in  cattle,  and  especially  in 
calves,  have  given  rise  to  poisoning  from  the  use  of  the 
meat  or  milk  of  the  infected  animals.  It  has  been  often 
demonstrated  that  bacteria  of  the  enteritidis-suipestifer 
group  are  associated  with  inflammation  of  the  udder 
in  cows  and  with  a  variety  of  septicemic  conditions  in 
cattle  and  other  domestic  animals  as  well  as  with 
manifestations  of  intestinal  disturbances  ("calf  diar- 
rhea," etc.).'  The  frequency  with  which  poisoning  has 
occurred  through  the  use  of  the  meat  of  "emergency- 
slaughtered"  animals  has  been  already  mentioned. 
K.  F.  Meyer^  has  reported  an  instance  of  accidental 
infection  in  a  laboratory  worker  caused  by  handling 
a  bottle  of  sterilized  milk  that  had  been  artificially 
contaminated  with  a  pure  culture  of  B.  enteriiidis  for 
experimental  purposes.     The  strain  responsible  for  the 

'  Although  not  directly  connected  with  the  cjuestion  of  food  poison- 
ing, it  is  of  interest  to  note  that  certain  diseases  of  birds  have  been 
traced  to  infection  with  members  of  this  group  of  bacteria.  In  a  few 
cases,  as  in  several  epidemics  among  parrots  in  Paris  and  elsewhere, 
the  infection  has"  been  communicated  to  man  by  contact. 

''Jour.  Infect.  Dis.,  XIX  (1916),  700. 


FOOD-BORNE  PATHOGENIC  BACTERIA  73 

infection  had  been  isolated  from  the  heart  blood  of  a 
calf  that  had  succumbed  to  infectious  diarrhea. 

2.  Human  contamination:  In  a  certain  number  of 
parat>T3hoid  food  infections  there  is  some  evidence  that 
the  food  was  originally  derived  from  a  healthy  animal 
and  became  infected  from  human  sources  during  the 
process  of  preparation.  In  addition  to  the  instances 
already  mentioned  (Reinhold  et  al.,  p.  67)  the  Ware- 
ham  (England,  19 10)  epidemic'  was  considered  by  the 
investigators  to  be  due  to  infection  of  meat  pies  by  a 
cook  who  was  later  proved  to  be  a  carrier  of  paratyphoid 
bacilli.  The  evidence  in  this  case,  however,  is  not 
altogether  conclusive.  Soderbaum^  mentions  a  milk- 
borne  paratyphoid  epidemic  occurring  in  Kristiania 
which  was  ascribed  to  infection  of  the  milk  by  a  woman 
milker.  Sacquepee  and  Bellot^  report  an  interesting 
paratyphoid  outbreak  involving  nineteen  out  of  two 
hundred  and  fifty  men  in  a  military  corps.  The  patients 
fell  ill  on  different  dates  between  June  14  and  June  21. 

It  was  found  that  an  assistant  cook  who  had  been  in  the 
kitchen  for  several  months  had  been  attacked  a  Uttle  before  the 
epidemic  explosion  by  some  slight  malady  which  was  not  definitely 
diagnosed.  He  had  been  admitted  to  the  hospital  and  was 
discharged  convalescent.  The  cook,  on  being  recalled  and 
quarantined,  stated  that  some  days  before  June  10  he  was  indis- 
posed with  headache  and  anorexia.  He  had  nevertheless  con- 
tinued   his    service    in   the   kitchen B.    paratyphosus    B 

{B.  suipestijer)  was  repeatedly  found  in  his  stools  in  August, 
September,  and  October In  all  probability,  therefore,  the 

'  R.  Trommsdorff,  L.  Rajchmann,  and  A.  E.  Porter,  Jour.  Ilyg., 
XI  (1911),  89. 

^  Hygiea,  LXXY  (igis),  i. 

J  Progres  med.,  3d  series,  XXVI  (1910),  25. 


74  FOOD  POISONING 

outbreak  was  due  to  food  contaminated  by  a  paratyphoid-carrier 
who  had  passed  through  an  abortive  attack  of  the  fever.' 

Bainbridge  and  Dudfield''  describe  an  outbreak  of  acute 
gastro-enteritis  occurring  in  a  boarding-house;  it  was 
found  that  no  one  article  of  food  had  been  eaten  by  all 
the  persons  affected,  and  there  were  other  reasons  for 
supposing  the  outbreak  to  be  due  to  miscellaneous  food 
contamination  by  a  servant  who  was  a  carrier. 

There  is,  therefore,  ground  for  believing  that  occa- 
sional contamination  of  food  may  be  brought  about 
by  bacteria  of  this  group  derived  from  human  sources. 
It  is  not  clear,  however,  how  frequent  this  source  of 
infection  is,  compared  to  infection  originating  in  diseased 
animals.  It  must  be  admitted,  too,  that  English  investi- 
gators are  disposed  to  look  upon  outbreaks  similar  to 
those  just  described  as  infections  with  B.  paratypho- 
sus  B,  an  organism  which  they  would  distinguish  from 
the  "true"  food  poisoning  bacilli,  B.  enteritidis  and 
B.  suipestifer. 

3.  Miscellaneous  contaminations:  Some  investiga- 
tors, especially  certain  German  writers,  regard  the  bacilli 
of  the  paratyphoid  group  as  so  widely  distributed 
in  nature  that  any  attempt  to  control  the  spread  of 
infection  is  like  fighting  windmills.  According  to  this 
view  the  bacilli  occur  commonly  in  our  everyday  sur- 
roundings and  thence  make  their  way  rather  frequently 
into  a  variety  of  foodstuffs.  Various  German  investi- 
gators have  reported  the  presence  of  paratyphoid  bacilli 
in  the  intestinal  contents  of  apparently  normal  swine, 
cattle,  rats,  and  mice  and  more  rarely  of  other  animals, 

'  Ledingham  and  Arkwright,  T/ie  Carrier  Problem  in  Infectious 
Diseases,  pp.  152-53. 

'Jottr.  Hyg.,  XI  (1911),  24. 


FOOD-BORNE  PATHOGENIC  BACTERIA  75 

in  water  and  ice,  in  German  sausage  and  chopped  meat, 
and  in  the  bodies  of  apparently  healthy  men.  To  what 
extent  their  alleged  ubiquity  is  due  to  mistaken  bacterial 
identification,  as  claimed  by  some  English  investigators, 
remains  to  be  proved.  There  is  no  doubt  that  in  some 
quarters  exaggerated  notions  have  prevailed  respecting 
a  wide  distribution  of  the  true  paratyphoid  bacteria. 
Savage  and  others  believe  that  the  hypothesis  that  food 
poisoning  outbreaks  are  derived  from  ordinary  fecal 
infection  of  food  is  quite  unfounded.  It  is  pointed  out 
that  there  is  good  evidence  of  the  frequent  occurrence 
of  intestinal  bacteria  in  such  food  as  sausages  and 
chopped  meat,  and  that  consequently,  if  paratyphoid 
infections  could  occur  through  ordinary  contamination 
with  intestinal  bacteria  not  connected  with  any  specific 
animal  infection,  food  poisoning  outbreaks  should  be 
exceedingly  common  instead  of — ^as  is  the  case — -com- 
paratively rare. 

At  the  present  tirtie  even  those  who  maintain  that 
these  bacilli  are  of  common  occurrence  admit  that  their 
abundance  is  more  marked  in  some  regions  than  in 
others.  Southwest  Germany,  for  example,  seems  to 
harbor  paratyphoid  bacilli  in  relatively  large  numbers. 
Possibly  local  differences  in  distribution  may  account 
for  the  discrepancies  in  the  published  findings  of  German 
and  British  investigators. 

A  special  case  is  presented  by  the  relation  of  these 
bacilli  to  rats  and  mice.  Among  the  large  number  of 
bacteria  of  the  paratyphoid  group  is  the  so-called 
Danysz  bacillus,  an  organism  quite  pathogenic  for 
rodents,  and  now  and  again  used  in  various  forms  as  a 
"rat  virus"  for  purposes  of  rodent  extermination. 
Several  outbreaks  of  food  poisoning  in  man  have  been 


76  FOOD  POISONING 

attributed  on  more  or  less  cogent  evidence  to  food 
contamination  by  one  of  these  viruses  either  directly 
by  accident,  as  in  the  case  described  by  Shibayama,'  in 
which  cakes  prepared  for  rats  were  eaten  by  men,  or 
indirectly  through  food  contaminated  by  mice  or  rats 
that  had  been  infected  with  the  virus/  The  use  of 
such  viruses  has  not  proved  of  very  great  practical  value 
in  the  destruction  of  rodents,  and  is  open  to  serious 
sanitary  objections,  since  the  animals  after  apparent 
recovery  can  continue  to  carry  the  bacilli  of  the  virus 
and  to  distribute  them  on  or  near  food  substances. 

It  seems  possible  that  rats  and  mice  may  become 
infected  with  certain  bacteria  of  this  group  without 
human  intervention,  and  that  these  infected  animals 
may  be  the  means  of  contaminating  foodstuffs  and  so 
causing  outbreaks  of  food  poisoning.  Proof  of  the 
frequency  with  which  this  actually  occurs  is  naturally 
difhcult  to  obtain. 

There  is  no  escape  from  the  conclusion  that  in  any 
given  case  of  food  poisoning  the  exact  source  of  infection 
is  often  largely  conjectural.  Even  when  suspicion  falls 
strongly  on  a  particular  article  of  food,  it  may  not  be 
possible  to  establish  beyond  a  reasonable  doubt  whether 
the  material  (meat  or  milk)  came  from  a  diseased  animal 
or  whether  it  was  infected  from  other  sources  (man  or 
other  animals)  at  some  stage  during  the  process  of  prepa- 
ration and  serving.  The  most  definitely  attested  cases 
yet  put  on  record  are  those  in  which  it  is  possible  to  trace 
the  infection  to  food  derived  from  an  ailing  animal. 

^  Miinch.  med.  Wchnschr.,  lAW  (1907),  979. 

^  See,  for  example,  H.  Langer  and  Thomann,  Deutsche  med. 
Wchnschr.,  XL  (19 14),  493. 


FOOD-BORNE  PATHOGENIC  BACTERIA  77 

Means  of  prevention.- — ^The  most  obvious  and  prob- 
ably the  most  important  method  of  preventing  infection 
with  paratyphoid  bacilh  is  the  adoption  of  a  system  of 
inspection  which  will  exclude  from  the  market  as  far 
as  possible  material  from  infected  animals.  To  be  most 
effective  such  inspection  must  be  directed  to  exam- 
ination of  the  living  animal.  The  milk  or  the  meat 
from  diseased  animals  may  give  no  visible  sign  of 
abnormality.  In  the  Ghent  outbreak  of  1895  the 
slaughter-house  inspector,  a  veterinary  surgeon,  was 
so  firmly  convinced  that  the  meat  which  he  had  passed 
could  have  had  no  connection  with  the  outbreak,  that 
he  ate  several  pieces  to  demonstrate  its  wholesomeness. 
The  experiment  had  a  tragic  ending,  as  the  inspector 
was  shortly  attacked  with  severe  choleraic  symptoms  and 
died  five  days  later,  paratyphoid  bacilli  being  found 
at  the  autopsy.  Miiller^  also  has  described  a  case  in 
which  paratyphoid  bacilli  were  found  in  meat  that  had 
given  rise  to  a  meat  poisoning  outbreak  although  the 
meat  was  normal  in  appearance  and  the  organs  of  the 
animal  showed  no  evidence  of  disease  to  the  naked  eye. 
It  is  evident  that  inspection  of  the  live  animal  will 
often  reveal  evidence  of  disease  which  might  be  missed 
in  the  ordinary  examination  of  slaughter-house  products. 

Although  inspection  of  cows  used  for  milking  and  of 
food  animals  before  slaughter  is  highly  important,  it 
does  not  constitute  an  absolute  protection.  Emphasis 
must  be  repeatedly  laid  on  the  fact  that  meat,  and 
especially  milk  that  is  derived  from  seemingly  healthy 
animals,  may  nevertheless  contain  paratyphoid  bacilli. 
To   meet   this   difficulty   in   part    the   direct   bacterial 

^  Zlschr.  f.  Infckiionsk d.  Haustiere,  VIII  (1910),  237. 


78  FOOD  POISONING 

examination  of  the  carcasses  of  slaughtered  food  animals 
has  been  proposed,  but  this  seems  hardly  practicable 
as  a  general  measure.  In  spite  of  all  precautions  taken 
at  the  time  of  slaughtering  it  seems  probable  that  occa- 
sionally paratyphoid-infected  meat  will  pass  the  first 
line  of  defense  and  be  placed  on  the  market. 

This  danger,  which  is  probably  not  a  very  grave 
one  under  a  reasonably  good  system  of  inspection  of  live 
animals,  may  be  met  by  thoroughly  cooking  all  foods 
of  animal  origin.  It  is  worth  noting  that  some  of  the 
internal  organs,  as  the  liver  and  kidneys,  are  more 
likely  to  contain  bacteria  than  the  masses  of  muscle 
commonly  eaten  as  "meat."  Sausages,  from  their 
composition  and  mode  of  preparation,  and  chopped 
meat  ("hamburger  steak")  are  also  to  be  treated  with 
especial  care.  Consumption  of  such  foods  as  raw 
sausage  or  diseased  goose  liver  (pate  de  foie  gras) 
involves  a  relatively  high  risk.  It  is  true  of  paratyphoid 
infection  as  of  most  other  forms  of  food  poisoning  that 
thorough  cooking  of  food  greatly  diminishes  the  likeli- 
hood of  trouble. 

Whatever  be  the  precise  degree  of  danger  from  food 
infection  by  healthy  paratyphoid- carriers  (man  or 
domestic  animals),  it  is  obvious  that  general  measures 
of  care  and  cleanliness  will  be  more  or  less  of  a  safeguard. 
As  with  typhoid  fever  so  all  outbreaks  of  paratyphoid 
should  be  thoroughly  investigated  in  order  that  the 
sources  of  infection  may  be  found  and  eliminated. 
The  possible  connection  of  rats  and  mice  with  these 
outbreaks  should  furnish  an  additional  incentive  to 
lessen  the  number  of  such  vermin  as  well  as  to  adopt 
measures  of  protecting  food  against  their  visits. 


CHAPTER  VII 
ANIMAL  PARASITES 

Not  only  pathogenic  bacteria  but  certain  kinds  of 
animal  parasites  sometimes  enter  the  human  body  in 
or  upon  articles  of  food.  One  of  the  most  important 
of  these  is  the  parasite  causing  trichiniasis. 

TRICHINIASIS 

Trichiniasis  or  trichinosis  is  a  disease  characterized 
by  fever,  muscular  pains,  an  enormous  increase  in  the 
eosinophil  blood  corpuscles,  and  other  more  or  less 
well-defined  symptoms;  at  the  onset  it  is  sometimes 
mistaken  by  physicians  for  typhoid  fever.  The  respon- 
sible parasite  is  a  roundworm  (Trichinella  spiralis, 
formerly  known  as  Trichina)  which  is  swallowed  while 
in  its  encysted  larval  stage  in  raw  or  imperfectly  cooked 
pork.'  The  cysts  or  envelopes  in  which  the  parasites 
live  are  dissolved  by  the  digestive  fluids  and  the  young 
larvae  which  are  liberated  develop  in  the  small  intestine 
to  the  adult  worm,  usually  within  two  days.  The 
young  embryos,  which  are  produced  in  great  numbers 
by  the  mature  worms,  gain  entrance  to  the  lymph 
channels  and  blood  stream,  and  after  about  ten  days 
begin  to  invade  the  muscles — ^a  procedure  which  gives 
rise  to  many  of  the  most  characteristic  symptoms  of 
the  infection.  It  is  estimated  that  in  severe  cases  as 
many  as  fifty  million  embryos  may  enter  the  circulation. 

'  The  consumption  of  raw  sausage  made  with  pig  meat  is  particu- 
larly likely  to  give  rise  to  trichiniasis. 

79 


8o 


FOOD  POISONING 


The  parasites  finally  quiet  down  and  become  encysted 
in  the  muscle  tissue  and  the  symptoms,  as  a  rule, 
gradually  subside.  Ingestion  of  a  large  number  of  para- 
sites at  one  time  often  results  fatally,  the  mortality 
from  trichiniasis  being  on  the  average  somewhat  over 
5  per  cent  and  rising  in  some  outbreaks  to  a  much  higher 

figure  (30  per  cent) . 
On  the  other  hand, 
many  infections 
are  so  light  as  to 
pass  unnoticed. 
Williams'  found 
Trichinella  em- 
bryos present  in 
5 . 4  per  cent  of  the 
bodies  of  persons 
dying  from  other 
causes.  Such  find- 
ings are  considered 
to  indicate  that  occasional  slight  Trichinella  infections 
even  in  the  United  States  are  quite  common.  This 
might  indeed  be  expected  from  the  frequent  occurrence 
of  infection  in  swine,  about  6  per  cent  of  these  animals 
being  found  to  harbor  the  parasite. 

The  specific  symptoms  (such  as  the  muscular  pain) 
of  trichiniasis  may  be  due  in  part  to  mechanical  damage 
of  the  muscle  tissue,  but  it  is  also  probable  that  they  are 
partly  due  to  toxic  products  exuded  by  the  worms  and 
partly  to  the  introduction  of  alien  protein  material — • 
the  protein  of  the  worm — into  the  tissues.  Secondary 
bacterial  infection  is  also  a  possibility,   but   there  is 

'  Jour.  Med.  Research,  VI  (1901),  64. 


Fig.  7. — Trichinae  encysted  in  inter- 
costal muscle  of  pig.  (About  35X1.)  (After 
Neumann  and  Mayer.) 


ANIMAL  PARASITES  8i 

little  evidence  to  prove  that  this  is  an  important  factor 
in  most  cases  of  trichiniasis.  The  various  stages 
observed  in  the  progress  of  the  disease  are  plainly 
connected  with  the  different  phases  of  the  worm's 
development — ^the  initial  localization  in  the  intestines, 
the  invasion  of  the  muscles,  and  the  final  encyst- 
ment. 

Swine  become  infected  with  this  parasite  by  eating 
scraps  of  infected  meat,  or  the  ofTal  of  their  own  kind, 
or  by  eating  infected  rats.  The  rat,  through  its  can- 
nibalistic propensities,  becomes  infected  frequently,  and 
is  one  of  the  chief  factors  in  the  wide  dissemination  of 
the  disease.  Human  infection  is  practically  accidental 
and  self-limited;  biologically  speaking,  man  as  a  host 
does  not  enter  into  the  calculations  of  the  parasite. 

Treatment  of  established  trichiniasis  infection  is 
palliative,  not  truly  remedial.  The  parasites,  once 
inside  the  body,  cannot  be  materially  affected  by  the 
administration  of  any  drug.  While  cure  of  trichiniasis 
is  thus  difficult,  if  not  impossible,  prevention  is  very 
simple.  The  thorough  cooking  of  all  food  is  sufiicient 
to  preclude  infection.  This  relatively  simple  means 
of  destroying  the  larvae  is  a  more  certain  as  well  as  less 
expensive  method  of  preventing  infection  than  is  the 
laborious  microscopic  examination  of  the  tissues  of 
every  slaughtered  hog.  In  Germany  between  1881  and 
1898  over  32  per  cent  of  6,329  cases  of  trichinosis  that 
were  investigated  were  traced  to  meat  that  had  been 
microscopically  examined  and  passed  as  free  from  tri- 
chinae.' On  the  other  hand,  thorough  cooking  removes 
all  possibihty  of  danger. 

'  Edelmann,  Mohler,  and  Eichhorn,  Meat  Hygiene,  19 16,  p.  182. 


82  FOOD  POISONING 

TENIASIS 

Various  tapeworm  or  cestode  infections  are  con- 
tracted by  eating  meat  containing  the  parasite.  Partic- 
ular species  of  tapeworm  usually  infest  the  flesh  of 
specific  hosts,  as  Tenia  saginata  in  the  beef  and  Tenia 
solium  in  the  hog.  The  dwarf  tapeworm,  Hymenolepis 
nana,  develops  in  rats,  and  the  human  infections  with 


Fig.  8. — Cysticerais  cdhdosac  in  pig's  tongue.     (After  Neumann  and  Mayer.) 

this  parasite  occasionally  observed  are  probably  caused 
by  contamination  of  food  by  these  animals. 

Sometimes  the  existence  of  the  tapeworm  in  man 
is  restricted  to  the  alimentary  tract  and  the  symptoms 
vary  from  trivial  to  severe,  but  sometimes  {Tenia 
solium)  the  larval  stage  of  the  tapeworm  invades  the 
tissues  and  becomes  encysted  in  various  organs  (brain, 
eye,  etc.),  where,  as  in  the  case  of  cerebral  infection,  it 
may  result  fatally.     The  encysted  larva  of  Tenia  solium 


ANIMAL  PARASITES  83 

was  at  one  time  regarded  as  an  independent  animal 
species  and  named  Cysticercus  cellidosae.  The  condition 
known  as  "measly  pork"  is  produced  by  the  occurrence 
of  this  encysted  parasite. 

So-called  hydatid  disease  is  due  to  the  cystic  growth 
produced  by  the  larva  of  a  species  of  tapeworm  {Echino- 
coccus)  inhabiting  the  intestine  of  the  dog.  Human 
infection  may  be  caused  by  contaminated  food  as  well 
as  more  directly  by  hands  soiled  with  petting  infected 
dogs.  Several  varieties  of  tapeworms  infesting  fish, 
especially  certain  fresh-water  species,  may  be  intro- 
duced into  the  human  body  in  raw  or  partly  cooked 
fish. 

Methods  for  the  prevention  of  tapeworm  infection 
include  the  destruction  of  the  larvae  by  heat — that  is, 
the  thorough  cooking  of  all  meat  and  fish — ^and  the 
minimization  of  close  contact  with  those  animals,  such 
as  the  dog  and  cat,  that  are  likely  to  harbor  parasites. 
Cleanliness  in  the  preparation  and  serving  of  food,  and 
attention  to  hand-washing  before  meals,  and  especially 
after  touching  pet  animals,  are  necessary  corollaries. 

UNCINARIASIS 

Hookworm  infection  (uncinariasis,  ankylostomiasis) 
is  commonly  caused  by  infection  through  the  skin  of 
the  feet,  but  the  possibility  of  mouth  infection  cannot 
be  disregarded,  and  in  regions  where  hookworm  disease 
exists  methods  of  guarding  against  food  contamination 
should  be  practiced,  as  well  as  other  precautions. 
Billings  and  Hickey^  believe  that  hookworm  disease  is 
contracted  by  unconscious  coprophagy  (from  raw  vege- 
tables) much  more  frequently  than  is  generally  supposed. 

^  Jour.  Amcr.  Med.  As^ioc,  LXVII  (1916),  igoS. 


84  FOOD  POISONING 

OTHER   PARASITES 

A  number  of  other  parasitic  worms  (e.g.,  Strong- 
yloides,  Ascaris  or  eelworm,  and  Oxyuria  or  pin  worm) 
may  conceivably  enter  the  human  body  in  contaminated 
food,  and  while,  as  in  hookworm  disease,  other  modes  of 
infection  are  probably  more  important,  the  liability  to 
occasional  infection  by  uncooked  food  must  not  be 
overlooked. 


Fig.  9. — Lamblia  Inleslinalis.     (After  Neumann  and  Mayer.) 

Various  forms  of  dysentery  or  diarrhea  have  been 
attributed  to  infection  with  Giardia  (Lamblia)  intes- 
tinalis.  Observations  made  by  Fantham  and  Porter' 
upon  cases  contracted  in  Gallipoli  and  Flanders  have 
given  support  to  this  view.  Strains  of  this  parasite  of 
human  origin  have  been  shown  to  be  pathogenic  for 
mice  and  kittens.  It  is  considered  possible  that  these 
animals  may  act  as  reservoirs  of  infection  and  spread 
the  disease  by  contamination  of  human  food. 

^  Brit.  Med.  Jour.,  II  (1916),  139. 


CHAPTER  VIII 

POISONOUS  PRODUCTS  FORMED  IN  FOOD  BY  BAC- 
TERIA AND  OTHER  MICRO-ORGANISMS 

In  close  relation  to  the  cases  of  infection  with  animal 
or  plant  parasites  which  have  been  discussed,  there 
are  certain  well-established  instances  of  poisoning  by 
substances  that  have  been  generated  in  food  while 
it  is  still  outside  of  the  body.  This  is  the  common 
tj-pe  of  food  poisoning  in  popular  estimation,  but  in 
point  of  fact  the  proved  cases  of  this  class  are  much 
less  frequent  than  the  instances  of  true  infection  with 
bacteria  of  the  paratyphoid-enteritidis  group  (chapter  vi). 
Thus  far  the  best-known  examples  of  poisoning  by  the 
products  of  micro-organisms  are  botulism  and  ergotism. 

ERGOTISM 

Ergotism  or  ergot  poisoning  is  due  to  the  use  of  rye 
that  has  become  diseased  through  the  attack  of  a  fun- 
gus, Claviceps  purpurea.  It  occurred  frequently  in  the 
Middle  Ages  when  in  times  of  famine  the  ergot  or 
spurred  rye  (O.Fr.  argot,  "a  cock's  spur")  was  often 
used  in  default  of  better  food.  In  Limoges  in  922  it  is 
said  that  forty  thousand  persons  perished  from  this 
cause.  Improvement  in  the  facilities  for  transportation 
of  food  into  regions  where  crops  have  failed,  and  the 
use  of  special  methods  for  separating  the  diseased  grain 
from  the  wholesome  have  greatly  reduced  the  prevalence 
of  ergotism.  In  Western  Europe  poisoning  from  this 
cause  has  practically  ceased,  although  Hirsch  recorded 


86  FOOD  POISONING 

some  twenty-eight  outbreaks  in  the  nineteenth  century; 
in  parts  of  Russia  the  disease  is  said  still  to  occur  in 
years  of  bad  harvest.' 

The  poison  ergot  itself  has  long  been  used  as  a  drug 
in  obstetrics,  but  its  composition  is  complex  and  is 
still  not  completely  understood.  Several  constituents 
of  ergot  have  been  extracted,  and  these  have  been 
shown  to  possess  different  physiological  effects.^  The 
symptoms  observed  in  the  outbreaks  of  ergotism  of 
mediaeval  times  are  not  wholly  reproduced  experi- 
mentally by  the  drug  and  are  thought  to  have  been 
in  part  due  to  the  semi-starvation  engendered  by  the 
use  of  rye  from  which  the  nutritious  portions  had  been 
largely  removed  by  the  growth  of  the  fungus. 

BOTULISM 

The  best  established  case  of  poisoning  by  means  of 
bacterial  products  taken  in  with  the  food  is  the  serious 
malady  known  somewhat  inappropriately  as  botulism 
(botulus,  sausage)  ?  This  kind  of  food  poisoning,  which 
has  a  characteristic  set  of  symptoms,  seems  to  have 
been   first  recognized   and   described   in    1820   by   the 

'  Another  species  of  Claviccps  (C.  pas  pall)  which  attacks  the  seeds 
of  a  wild  grass  is  believed  to  be  responsible  for  certain  outbreaks  of 
poisoning  among  cattle  and  horses  (Science,  XLIII  [1916],  894). 

^  Barger  (Jour.  Chem.  Soc,  XCV  [1909],  11 23)  has  shown  that 
parahydroxyphenylethylamine  is  present  in  ergot  and  is  in  some  degree 
responsible  for  the  physiological  action  of  the  drug. 

s  Although  some  of  the  early  outbreaks  were  traced  to  the  use  of 
sausage,  particularly  in  VViirttemberg,  the  proportion  of  recent  botulism 
poisoning  attributed  to  this  food  is  no  greater  than  of  sausage-conveyed 
infections  with  the  paratyphoid  bacillus  (chap,  vi) ,  and  a  number  of  the 
most  completely  studied  outbreaks  of  botulism  have  been  traced  to 
ham,  beans,  and  other  foods. 


POISONOUS  PRODUCTS  FORMED  IN  FOOD        87 

German  poet  and  medical  writer  Justinus  Kerner.     In 
two  articles  (1820-22)  he  enumerates  174  cases  with  71 


Fig.  10. — Claviceps  purpurea:  i,  ergot  on  rye-grass;  2,  ergot  on 
rye;  3,  section  of  a  portion  of  the  conidial  form  of  fruit,  X300;  4,  a 
sclerotium  or  ergot;  5,  head  of  ascigerous  form  of  fruit;  6,  an 
ascus,  X300;  7,  a  single  spore,  X300.  (After  Massee,  Plant  Diseases, 
by  courtesy  of  the  Macmillan  Company.) 

deaths  occurring  in  Wiirttemberg  between  1793  and  1822 
and  apparently  in  most  cases  connected  with  the  use 


88  FOOD  POISONING 

of  insufficiently  smoked  sausage.  Mayer'  tabulates 
about  600  additional  cases  observed  in  various  parts  of 
Germany  down  to  the  end  of  1908,  the  total  mortality 
in  the  800  cases  being  about  25  per  cent.  In  France 
botulism  is  said  to  be  very  rare.^  In  Great  Britain 
Savage^  declares  that  he  has  been  unable  to  trace  the 
occurrence  of  a  single  outbreak.  In  the  United  States 
several  instances  of  botulism  poisoning  are  on  record 
(Sheppard/  1907,  3  cases,  3  deaths,  canned  pork  and 
beans;  Peck,^  1910,  12  cases,  11  deaths;  Wilbur  and 
Ophiils,^  1914,  canned  string  beans,  12  cases,  i  death; 
Frost/  1915,  3  cases,  3  deaths).  Professor  Stiles^  has 
given  a  graphic  description  of  his  own  attack  of  probable 
botulism  due  in  all  likehhood  to  minced  chicken. 

Symptoms. — The  description  of  a  case  seen  by 
Wilbur  and  Ophiils'  is  so  typical  that  it  may  be  cited: 

Girl,  aged  23,  Tuesday  evening,  Nov.  23,  1913,  ate  the  dinner 
including  the  canned  string  beans  of  the  light  green  color  together 
with  a  little  rare  roast  beef.  The  following  day  she  felt  perfectly 
normal  except  that  at  10:00  in  the  evening  the  eyes  felt  strained 
after  some  sewing.  Thursday  morning,  thirty-six  hours  after 
the  meal,  when  the  patient  awoke,  the  eyes  were  out  of  focus, 
appetite  was  not  good,  and  she  felt  very  tired.  At  night  she  had 
still  no  appetite,  was  nauseated,  and  vomited  the  noon  meal 
apparently    undigested.     Friday    morning,    two    and    one-half 

'  Deutsche  Vlertelj.f.  ojfentl.  Ges.,  XLV  (1913),  8. 
^E.  Sacquepee,  Progres  med.,  XXVI  (1910),  583. 
3  Report  to  Local  Govt.  Board  on  Bacterial  Food  Poisoning  and  Food 
Inspection,  N.S.  No.  77,  1913,  p.  27. 

*  Southern  Cal.  Pract.,  XXII  (1907),  370. 

5  Ibid.,  XXV  (1910),  121. 

^Arch.  of  Int.  Med.,  XIV  (1914),  589- 

T  Amer.  Med.,  X  (1915),  85. 

^  Jour.  Amer.  Med.  Assoc,  LXI  (1913),  2301.        '^  Loc.  cit. 


POISONOUS  PRODUCTS  FORMED  IN  FOOD       89 

days  after  the  meal,  the  eyes  were  worse,  objects  being  seen  double 
on  quick  movement,  and  it  was  noticed  that  they  had  a  tendency 
to  be  crossed.  A  peculiar  mistiness  of  vision  was  also  complained 
of.  She  was  in  bed  until  late  in  the  afternoon,  when  she  visited 
Dr.  Black.  She  had  had  some  disturbance  in  swallowing  previous 
to  this  time  and  stated  that  it  felt  as  if  "something  came  up  from 
below"  that  interfered  with  deglutition.  The  fourth  day  she 
remained  in  bed,  was  much  constipated,  and  noticed  a  marked 
decrease  in  the  amount  of  urine  voided.  There  was  at  no  time 
pain  except  for  occasional  mild  abdominal  cramps,  no  headache, 
subnormal  temperature,  and  a  normal  pulse.  The  fourth  and 
fifth  days  the  breathing  became  difiicult  at  times  and  swallowing 
was  almost  impossible.  The  patient  complained  of  a  dry  throat 
with  annoying  thirst.  The  sixth  day  there  were  periods  of  a 
sense  of  suffocation  with  a  vague  feeling  of  unrest  and  as  if  there 
might  be  difficulty  in  getting  the  next  breath.  The  upper  lids 
had  begun  to  droop.  The  voice  was  nasal.  When  the  attempt 
was  made  to  swallow  liquids  they  passed  back  through  the  nose. 
The  patient  felt  markedly  weak. 

Physical  examination  at  this  time  showed  ptosis  of  both 
upper  eyelids,  dilatation  of  the  right  pupil,  sluggish  reaction  to 
light  of  both  pupils,  apparent  paralysis  of  the  internal  rectus  of 
the  left  eye,  normal  retina,  inabiUty  to  raise  the  head,  control 
apparently  having  been  lost  of  the  muscles  of  the  neck,  inability 
to  swallow,  absence  of  taste.  The  tongue  was  heavily  coated 
and  the  throat  was  covered  with  a  viscid  whitish  mucus  clinging 
to  the  mucous  membrane.  The  soft  palate  could  be  raised  but 
was  sluggish,  particularly  on  the  right  side.  The  exudate  on  the 
right  tonsil  was  so  marked  that  it  resembled  somewhat  a  diph- 
theritic membrane.  The  seventh  day  there  was  some  change  in 
the  condition;  occasional  periods  occurred  when  swallowing 
was  more  effective,  and  there  was  less  tendency  to  strangle.  On 
the  eleventh  day  there  was  some  improvement  of  the  eyes,  still 
strangling  on  swallowing,  sensation  of  taste  was  keener,  and  the 
general  condition  improved.  The  twelfth  day  the  patient  was 
able  to  move  her  head,  but  was  unable  to  lift  it  except  when  she 
took  hold  of  the  braids  of  her  hair,  and  pulled  the  head  forward. 
The  eyes  could  be  opened  slightly,  speech  was  less  nasal  and 


go  FOOD  POISONING 

more  distinct,  and  improvement  in  swallowing  was  marked.  At 
the  end  of  two  weeks  the  patient  was  able  to  take  soft  diet  freely, 
and  at  four  weeks  she  was  up  in  a  chair  for  a  couple  of  hours 
complaining  only  of  general  weakness  and  inability  to  use  her 
eyes.  At  the  end  of  five  weeks  she  was  able  to  leave  the  hospital 
and  return  to  her  home  and  later  to  resume  her  regular  work. 

In  all  cases  the  nervous  system  is  strikingly  affected 
in  this  form  of  food  poisoning.  Dizziness,  double  vision, 
difficulty  in  chewing  and  swallowing,  and  other  symp- 
toms of  nervous  involvement  occur  with  varying  in- 
tensity and  may  persist  for  a  long  time  after  the  first 
signs  of  the  attack.  Temperature,  pulse,  and  respiration 
remain  practically  normal.  In  contrast  with  the 
traditional  t>pe  of  food  poisoning  gastro-intestinal 
symptoms  may  be  sKght  or  altogether  lacking.  Freedom 
from  abdominal  pain  is  usually  noted;  diarrhea  is  the 
exception  and  constipation  the  rule;  vomiting  sometimes 
occurs,  but  may  be  absent.  In  the  cases  described  by 
Sheppard  there  was  "an  entire  absence  of  the  usual 
gastro-intestinal  s>Tnptoms  from  first  to  last,  no  pain 
or  sensory  disturbance  and  no  elevation  of  temperature." 
The  visual  disturbances  are  very  characteristic.  Stiles 
relates  his  own  experiences  as  follows: 

Vertigo  and  nystagmus  developed  [a  few  hours  after  eating] 
in  a  startling  degree,  the  car  [in  which  he  was  being  taken  to  his 
house]  seemed  to  be  ascending  an  endless  spiral,  the  stars  made 
circles  in  the  sky,  and  the  houses  by  the  wayside  reeled.  The 
lighted  doorway  of  my  house  seemed  to  approach  and  surround 
me  as  I  was  carried  in.  My  bed  for  the  moment  presented  itself 
as  a  vertical  surface  which  I  could  not  conceive  to  be  a  resting 

place Whenever  I  opened  my  eyes  on  this  day  [the  next 

day]  the  impression  of  gyration  of  the  room  was  appalling 

To  turn  my  head  even  very  slowly  from  one  side  to  the  other 
brought  an  accession  of  the  overpowering  giddiness  ....  [eight 


POISONOUS  PRODUCTS  FORMED  IN  FOOD        91 

days  after  the  bcjjjinning  of  the  attack].  'i1ie  nystagmus  now 
became  limited  to  momentary  onsets,  but  in  its  place  I  became 
aware  of  a  peculiar  diplopia.  The  image  of  one  retina  was  not 
merely  displaced  from  the  position  of  its  fellow  but  was  tilted 

about    15   degrees  from  parallel This   fantastic  diplopia 

gradually  gave  place  to  the  familiar  variety  and  this  occurred 
less  and  less  often  as  my  convalescence  proceeded.  From  [this 
date]  my  recovery  pursued  a  course  which  was  dishearteningly 
slow  but  free  from  any  setbacks.  Among  the  persistent  symptoms 
were  ....  the  visual  difficulties  mentioned.  The  left  pupil 
was  usually  smaller  than  the  right  and  I  thought  I  detected  a 
slight  failure  to  relax  accommodation  with  the  left  eye.  Reading 
was  difficult  for  several  weeks  and  the  ability  to  write,  as  requiring 
closer  fixation,  was  still  longer  in  returning. 

In  the  cases  reported  by  Sheppard  visual  symptoms 
were  the  initial  signs  of  trouble,  double  vision,  mistiness, 
and  inability  to  hit  the  mark  in  shooting  being  the  first 
complaint. 

The  time  elapsing  betw^een  eating  the  implicated  food 
and  the  onset  of  the  earliest  symptoms  is  usually  between 
twelve  and  forty-eight  hours,  but  may  be  much  less. 
In  Stiles's  case  the  interval  was  apparently  less  than 
three  hours. 

Anatomical  lesions. — ^In  fatal  cases  no  characteristic 
gross  changes  are  observed  in  the  various  organs.  It 
has  been  stated  by  some  writers  that  microscopic 
degenerative  changes  occur  in  the  ganglion  cells,  involv- 
ing especially  the  so-called  Nissl  granules,  but  in  the 
carefully  studied  case  reported  by  Ophiils'  the  Nissl 
granules  were  quite  normal  in  size,  arrangement,  and 
staining  qualities.  There  was,  in  fact,  no  evidence  to 
substantiate  the  hypothesis  of  a  specific  action  of  the 
toxin  on  the  nerve-cells.     On  the  other  hand,  Ophiils 

'  Loc.  cit. 


92  FOOD  POISONING 

found  numerous  hemorrhages  in  the  brain-stem  and 
multiple  thromboses  in  both  the  arteries  and  veins. 
He  holds,  consequently,  that  the  indications  of  severe 
disturbances  of  brain  circulation  associated  with  hemor- 
rhages and  thrombosis  in  medulla  and  pons  are  sufficient 
to  explain  the  symptoms  of  botulism  poisoning  without 
having  recourse  to  the  assumption  that  the  poison  has 
a  specific  action  on  certain  ganglion  cells. 

Bacteriology. — ^The  cause  of  botulism  poisoning  was 
discovered  by  Van  Ermengem  to  be  the  toxin  produced 
by  a  bacillus  which  he  named  B.  botulinus.  This 
organism  was  isolated  from  portions  of  a  ham  that  had 
caused  fifty  cases  of  poisoning  (1895)  at  Ellezelles 
(Belgium),  and  also  from  the  spleen  and  gastric  contents 
of  one  of  the  three  fatal  cases.  The  bacillus  grows  only 
in  the  absence  of  oxygen  (strict  anaerobe),  stains  by 
Gram's  method,  forms  terminal  spores,  and  develops  best 
at  22°  C.  Unlike  most  bacteria  dangerous  to  man,  it 
appears  unable  to  grow  in  the  human  body,  and  its 
injurious  effect  is  limited  to  the  action  of  the  toxin 
produced  in  foodstuffs  outside  the  body.  Botulism  is 
an  intoxication — not  an  infection.  The  fact  that  the 
bacillus  can  grow  in  nature  only  when  the  free 
oxygen  supply  is  cut  off  explains  in  part  at  least  the 
relatively  rare  occurrence  of  botulism  since  all  the 
conditions  necessary  for  the  production  of  the  botulism 
toxin  do  not  commonly  concur.  Next  to  nothing  is 
known  as  to  how  widely  B.  botulinus  is  distributed. 
Except  in  connection  with  the  cases  of  poisoning  it  has 
been  reported  but  once  in  nature.^     The  botulism  poison 

'  In  the  feces  of  a  healthy  pig  (Kempner  and  Pollock,  Deutsche 
med.  Wchnschr.,  XXIII  [1897],  505). 


POISONOUS  PRODUCTS  FORMED  IN  FOOD        93 

is  a  true  bacterial  toxin,  chemically  unstable,  destroyed 
by  heating  at  8o°C.  for  30  minutes,  capable  of  provoking 
violent  symptoms  in  minute  doses,  and  possessing  the 
property  characteristic  of  all  true  toxins  of  generating 
an  antitoxin  when  injected  in  small,  non-fatal  doses 
into  the  bodies  of  susceptible  animals.  In  animal 
experiments    the    toxin 

formed  by  B.  botulinus  .  ^   *  /»  n^ 

has  been  found  capable  •  ■  1        V 

of  reproducing  the  typi-      •  ^^       ^        f 

cal  clinical  picture  of  '  f  /^ ^y  \  y  ^^  \ 
this  form  of  food  poison-      ' ■   ^  /  ^\ 

ing.  Symptoms  of  /«^  \  j|  •  \  ^  \ 
paralysis  are    produced     \  **'       ^ 

in  rabbits,  guinea-pigs,  ^^  . 

and   other    animals   by  v  g  •^■ 

the  injection  of  so  small  ft 

a  dose  as  O.OOOI   C.C.  of  Y\q..  h— Bacillus   bolulimis  with 

a  filtered  broth  culture,  spores.     Pure  culture  on  sugar-gelatin. 

Epidemiology. ^The  ^'^"   Ermengem  preparation.     (Kolle 

,.,.                  ,            ,  .   ,  and  Wassermann.) 

conditions  under  which 

B.  botulinus  occurs  and  is  given  opportunities  for  multiply- 
ing are  not  completely  known.  It  is  possible  that  there 
are  localities  where  this  bacillus  is  particularly  abundant 
in  the  soil  or  in  the  intestinal  contents  of  swine  or  other 
domestic  animals,  but  on  the  whole  it  seems  more 
probable  that  the  organism  is  widely  distributed,  but 
that  it  does  not  often  find  suitable  conditions  for  entrance 
into,  and  multiplication  in,  human  food.  Practically 
all  the  reported  cases  of  botulism  have  been  caused 
by  food  which  has  been  given  some  sort  of  preHminary 
treatment,    as    smoking,    pickling,    or    canning,    then 


94  FOOD  POISONING 

allowed  to  stand  for  a  time,  and  eaten  before  cooking. 
Since  both  the  bacillus,  including  the  spore  stage,  and 
its  toxin  are  destroyed  by  relatively  slight  heating,  it  is 
clear  that  a  rather  unusual  set  of  factors  must  co-operate 
in  order  that  botulism  poisoning  shall  take  place. 
These  are  evidently:  (i)  the  presence  of  the  bacilli  in 
sufficient  numbers  in  a  suitable  foodstuff;  (2)  the  initial 
preparation  of  the  food  by  a  method  that  does  not 
destroy  the  B.  hotulinus — inadequate  smoking,  too 
weak  brine,^  or  insufficient  cooking;  (3)  the  holding  of 
this  inadequately  preserved  food  for  a  sufficient  length 
of  time  under  the  right  conditions  of  temperature  and 
lack  of  oxygen;  (4)  the  use  of  this  food,  in  which  con- 
ditions have  conspired  to  favor  the  production  of  toxin 
by  B.  hotulinus,  without  final  adequate  cooking.  It 
seems  as  reasonable  to  suppose  that  the  infrequency 
with  which  these  several  factors  coincide  is  responsible 
for  the  relative  uncommonness  of  botulism  as  to  suppose 
it  due  to  the  rarity  of  the  specific  bacillus.  In  the 
Belgian  outbreak  studied  by  Van  Ermengem  the  poison- 
ous ham  had  lain  at  the  bottom  of  a  cask  of  brine 
(anaerobic  conditions)  while  the  other  ham  of  the 
same  animal  lay  on  top  of  it  but  was  not  covered  with 
brine,  and  was  eaten  without  producing  any  poisonous 
effect.  In  this  instance  the  presence  or  absence  of 
favorable  conditions  for  anaerobic  growth  seemed  to 
be  the  decisive  factor. 

Prevention  and  treatment. — The  food  in  which  B. 
hotulinus  has  grown  does  not  seem  to  be  altered  in  a  way 

'  B.  hotulinus  does  not  develop  in  media  containing  over  6  per  cent 
of  salt  and  should  not  be  able  to  grow  in  meat  properly  covered  in  brine 
made  with  10  per  cent  of  salt  (Romer,  Centralbl.f.  Bakt.,  XXVII  [1900], 
8S7). 


}?OISONOUS  PRODUCTS  FORMED  IN  FOOD        95 

that  nccessaril)'  arouses  suspicion.  In  the  case  de- 
scribed by  Romer  the  incriminated  ham  showed  bluish- 
gray  areas  from  which  B.  Iwtulinus  could  be  isolated, 
but  this  condition  does  not  seem  to  have  attracted 
attention  before  the  poisoning  occurred  and  was  an 
observation  made  only  after  the  event.  So  far  as  can 
be  learned  the  meat  that  has  caused  botulism  has 
always  come  from  perfectly  sound  animals.  In  some 
cases  the  accused  article  of  food  is  said  to  have  had  a 
rancid  or  acrid  taste  (due  to  butyric  acid?),  but  there 
is  nothing  definitely  characteristic  about  this,  as  the 
majority  of  anaerobes  produce  butyric  acid.  If,  as  in 
the  Darmstadt^  and  Stanford  University^  epidemics,  the 
food  (canned  beans)  is  served  with  salad  dressing,  a  sour 
taste  might  pass  without  notice  or  even  add  to  the 
relish.  In  the  instance  reported  by  Sheppard  the 
canned  beans  were  good  in  appearance,  taste,  and  smell. 
The  obvious  precaution  to  take  against  poisoning  of 
this  sort  is  first  the  use  of  adequate  methods  of  food 
preservation.  To  judge  from  the  recorded  outbreaks, 
domestically  prepared  vegetables  and  meats  are  more 
hkely  to  give  rise  to  botulism  than  those  prepared 
commercially  on  a  large  scale.  The  general  use  of  steam 
under  pressure  in  the  large  canning  factories  affords  a 
high  degree  of  protection  against  the  anaerobic  bacteria 
and  their  resistant  spores.  Whatever  the  method  of 
treatment,  all  canned  or  preserved  food  having  an 
unnatural  appearance,  taste,  or  odor  should  be  rejected. 
Reheating  of  all  prepared  foods  immediately  before 
use  is  an  additional  safeguard.     Foods,  such  as  salads, 

■  G.  Landmann,  Hyg.  Rundschau,  XIV  (1904),  449. 

=  Wilbur  and  Ophiils,  Arch,  of  Int.  Med.,  XIV  (1914),  589. 


96  FOOD  POISONING 

composed  wholly  or  in  part  of  uncooked  materials 
should  not  be  allowed  to  stand  overnight  before  being 
served. 

If  symptoms  of  botulism,  such  as  visual  disturbances, 
become  manifest,  the  stomach  should  be  emptied  with 
a  stomach  pump,  cathartics  administered,  and  strych- 
nine and  other  stimulants  given  as  required.  Since  one 
of  the  noteworthy  features  of  this  disease  is  the  paralysis 
of  the  intestinal  tract  by  the  toxin  absorbed,  the  guilty 
food  may  lie  for  a  long  time  in  the  stomach  (cf.  Stiles, 
loc.  cit.).  Consequently,  measures  to  empty  the  stom- 
ach should  be  taken  even  if  the  patient  does  not  come 
under  observation  until  several  days  after  the  poisonous 
food  has  been  eaten. 

An  antitoxic  serum  has  been  prepared  at  the  Koch 
Institute  in  Berlin.  This  serum  has  given  successful 
results  in  animal  experimentation,  but  has  not  been 
used,  so  far  as  I  can  learn,  in  any  human  outbreak.  It 
is  not  available  at  any  point  in  this  country. 

OTHER  BACTERIAL   POISONS 

The  interesting  case  reported  by  Barber""  shows  that 
there  are  other  possibilities  of  food  poisoning  by  formed 
bacterial  poisons.  Acute  attacks  of  gastro-enteritis 
were  produced  in  several  individuals  by  the  use  of  milk 
containing  a  poisonous  substance  elaborated  by  a  white 
staphylococcus.  This  staphylococcus  occurred  in  almost 
pure  culture  in  the  udder  of  the  cow  from  which  the 
milk  was  derived.  The  milk  when  used  fresh  was  harm- 
less and  the  poison  was  generated  in  effective  quantities 
only  when  the  milk  stood  some  hours  at  room  tempera- 

'  Phil.  Jour,  of  Science,  IX  (1914),  B6,  p.  515. 


POISONOUS  PRODUCTS  FORMED  IN  FOOD        97 

turc  before  being  used.     The  symptoms  were  similar 
to  those  usually  ascribed  to  "ptomain  poisoning." 

SPOILED   AND   DECOMPOSED  FOOD 

There  is  a  general  belief  that  food  is  unwholesome 
whenever  the  evidence  of  the  senses  shows  it  to  be 
more  or  less  decomposed.  This  opinion  finds  expres- 
sion in  civilized  countries  in  many  legal  enactments 
forbidding  traffic  in  decomposed  meats,  vegetables,  and 
fruits.  There  is  unfortunately  lack  of  evidence  as  to 
what  kinds  or  degree  of  visible  decomposition  are  most 
dangerous.  In  fact,  some  foods  of  high  nutrient  value, 
notably  cheeses,  are  eaten  only  after  somewhat  extensive 
decomposition  processes  (termed  ripening)  have  taken 
place.  The  characteristic  flavors  or  aromas  of  the  vari- 
ous hard  and  soft  cheeses  are  due  to  the  substances 
formed  by  certain  species  of  molds  and  bacteria  and  are 
just  as  properly  to  be  regarded  as  decomposition  products 
as  the  unpleasant  stenches  generated  by  decomposing 
eggs  or  meat.  Indeed,  some  of  the  decomposition  prod- 
ucts formed  in  the  ripening  of  Brie,  Camembert,  or  Lim- 
burger  are  similar  to,  if  not  identical  with,  those  which 
are  associated  with  spoiled  foods.  Sour  milk,  again,  is 
recommended  and  commonly  used  as  a  food  or  beverage 
for  persons  in  delicate  health,  and  yet  sour  milk  contains 
many  millions  of  bacteria  and  their  decomposition 
products.  Some  of  the  bacteria  commonly  concerned 
in  the  natural  souring  of  milk  are  closely  related  to 
pathogenic  types.  The  partial  decomposition  of  meats 
and  game  birds  is  often  considered  to  be  advantageous 
rather  than  otherwise.  Even  eggs,  a  food  whose 
''freshness"  is  marred  for  most  persons  by  the  initial 


98  FOOD  POISONING 

stages  of  decomposition,  are  ripened  in  various  ways 
by  the  Chinese  and  eaten  as  a  delicacy  after  the  lapse 
of  months  or  years.  The  preserved  ducks'  eggs  known 
as  pidan  are  stored  for  months  in  a  pasty  mixture  of 
tea,  lime,  salt,  and  wood  ashes.  "They  are  very  dif- 
ferent from  fresh  eggs.  The  somewhat  darkened  shell 
has  numerous  dark  green  dots  on  the  inner  membrane. 
Both  the  white  and  yolk  are  coagulated;    the  white  is 

brown,  more  or  less  like  coffee  jelly "^     Increase 

of  ammoniacal  nitrogen  has  taken  place  to  an  extraor- 
dinary degree  in  these  eggs,  indicating  much  decompo- 
sition of  the  egg  protein.  The  ammoniacal  nitrogen 
in  pidan  is  considerably  higher  than  in  the  eggs  known 
by  egg  candlers  as  black  rots. 

It  is  evident,  therefore,  that  bacterial  growth  in 
substances  used  as  food  is  not  necessarily  injurious  and 
may  in  some  cases  increase  the  palatability  of  food 
without  destroying  its  wholesomeness.  Little  or  nothing 
is  known  about  the  correlation  of  visible  signs  of  decom- 
position with  the  presence  of  poisonous  products,  and 
it  is  at  present  impossible  to  say  at  what  point  in  the 
process  of  decomposition  a  food  becomes  unfit  to  use 
owing  to  the  accumulation  of  poisonous  substances 
within  it.  There  seems  to  be  no  connection  between 
the  natural  repugnance  to  the  use  of  a  food  and  its 
unwholesomeness.  Under  ordinary  conditions  the  nau- 
seous character  of  very  stale  eggs  is  proverbial,  and 
yet  few  nitrogenous  foods  have  so  clear  a  health  record 
as  eggs  or  have  been  so  infrequently  connected  with 
food  poisoning  outbreaks. 

'  K.  Blunt  and  C.  C.  Wang,  Jour.  Biol.  Chcm.,  XXVIII  (1916),  125. 


POISONOUS  PRODUCTS  FORMED  IN  FOOD        99 

It  might  seem  tempting  to  conclude  on  the  basis  of 
the  available  evidence  that  spoiled  or  decomposed  foods 
possess  poisonous  qualities  only  when  certain  specific 
bacteria,  like  the  B.  hotulinus  already  discussed,  have 
accidentally  invaded  them  and  formed  definite  and 
specific  poisons.  But  we  have  no  right  to  assume  that 
the  everyday  decomposition  products  of  the  banal 
bacteria  are  in  all  cases  without  injurious  effects.  Even 
though  no  sharply  defined  acute  form  of  poisoning  may 
be  laid  at  their  door,  it  does  not  follow  that  an 
irritating  or  perhaps  sUghtly  toxic  action  of  the  ordinary 
decomposition  products  is  altogether  absent.  Our  pres- 
ent knowledge  of  the  nature  and  degree  of  danger  to  be 
apprehended  from  the  use  of  spoiled  food  is  imperfect 
and  unsatisfactory.  That  fact,  however,  does  not  release 
us  from  the  obligation  to  continue  measures  of  protec- 
tion based  even  to  a  limited  extent  on  experience. 


CHAPTER  IX 
POISONING  OF  OBSCURE  OR  UNKNOWN  NATURE 

While  many  and  diverse  causes  of  food  poisoning 
have  been  discussed  in  the  foregoing  pages,  there  remain 
certain  affections  definitely  connected  with  food  that 
are  still  of  obscure  or  doubtful  causation. 

MILKSICKNESS   OR   TREMBLES 

This  disease,  common  to  man  and  some  of  the  higher 
animals,  is  characterized  by  a  definite  symptom-complex, 
the  salient  features  being  excessive  vomiting  and 
obstinate  constipation  accompanied  usually  by  a  sub- 
normal temperature.  Many  cases  result  fatally.  At 
the  present  time  it  is  known  to  occur  only  rarely  in  some 
of  the  southern  and  central  western  states  in  this  country, 
but  during  the  period  of  pioneer  settlement  it  was  quite 
common  in  districts  that  are  now  seldom  affected.  A 
great  many  references  to  milksickness  are  found  in  the 
writings  of  the  early  travelers  and  physicians  in  the 
Middle  West,  one  observer  predicting  that  "some  of 
the  fairest  portions  of  the  West  in  consequence  of  the 
prevalence  of  this  loathsome  disease  must  ever  remain 
an  uninhabitable  waste  unless  the  cause  and  remedy 
can  be  discovered."  In  certain  regions  it  is  estimated 
that  "nearly  one-fourth  of  the  pioneers  and  early  settlers 
died  of  this  disease."  The  mother  of  Abraham  Lincoln 
fell  a  victim  to  this  malady  in  1818  in  southern  Indiana. 

The  disease  appears  to  be  usually  contracted  in  the 
first  instance  by  grazmg  cattle  or  sheep  that  have  access 


POISONING  OF  UNKNOWN  NATIJ-RE'  ioi.- 

to  particular  tracts  of  land;  ''milksickness"  pastures 
are,  as  a  rule,  well  known  locally  for  their  danger- 
ous qualities.  Milksickness  is  communicated  to  man 
through  the  medium  of  raw  milk  or  butter  and  possibly 
of  meat.  Although  some  of  the  earlier  observers  make 
the  statement  that  the  disease  is  self-propagating  and 
can  be  passed  on  without  limit  from  one  animal  to 
another,  later  experiments  cast  doubt  on  this  view.^ 

Many  different  theories  have  been  advanced  to 
account  for  the  origin  of  the  disease.  The  belief  that 
mineral  poisons  such  as  arsenic  or  copper  might  be 
taken  up  by  grazing  animals  and  eliminated  in  the  milk 
finds  no  justification  either  in  analytical  or  in  clinical 
data.  Many  plants,  known  or  suspected  to  be  poison- 
ous, have  been  accused  of  furnishing  the  substance  that 
imparts  the  poisonous  quality  to  the  milk  of  animals 
suffering  from  trembles,  but  there  is  no  agreement  as  to 
the  responsible  species.  Feeding  experiments  with  sus- 
pected plants  have  in  no  case  given  unambiguous  results. 
While  some  facts  have  been  supposed  to  indicate  that 
living  micro-organisms  are  the  cause  of  milksickness, 
other  facts  are  opposed  to  this  view,  and  the  most  recent 
experiments  in  this  direction  did  not  lead  to  conclusive 
results.^  The  true  cause  of  milksickness  is  at  present 
quite  unknown. 

DEFICIENCY  DISEASES 

Although  diseased  conditions  due  to  the  absence 
rather  than  the  presence  of  certain  constituents  in  the 
food  are  not  perhaps  to  be  properly  classed  as  food 

'  Jordan  and  Harris,  Jour.  Infect.  Dis.,  VI  (1909),  401. 
'Ibid. 


I02  FOOD  POISONING 

poisoning,  they  may  be  mentioned  here  to  illustrate 
the  complexity  of  the  food  problem.  At  least  one 
disease — ^pellagra — is  attributed  by  some  observers  to 
the  presence  of  an  injurious  substance  or  micro-organism 
in  the  food,  and  by  others  to  the  absence  of  certain 
ingredients  necessary  to  the  proper  maintenance  of  life. 
Beriberi. — One  of  the  best  established  instances  of  a 
disease  due  to  a  one-sided  or  defective  diet  is  beriberi. 
This  affection  is  prevalent  among  those  peoples  subsist- 
ing chiefly  or  wholly  on  a  diet  of  rice  prepared  in  a  certain 
way.  As  a  matter  of  trade  convention  milled  white 
rice  has  long  been  considered  superior  to  the  unpolished 
grain.  The  process  of  polishing  rice  by  machinery 
removes  the  red  husk  or  pericarp  of  the  grain,  and  a 
diet  based  almost  exclusively  on  polished  rice  causes 
this  well-marked  disease — beriberi — which  was  for  long 
regarded  as  of  an  infectious  nature.^  It  has  been 
shown  that  if  the  husks  are  restored  to  the  polished 
grain  and  the  mixture  used  as  food  the  disease  fails  to 
develop.  Experiments  upon  chickens  and  pigeons  show 
that  an  exclusive  diet  of  white  rice  causes  in  these 
animals  a  disease  (polyneuritis  of  fowls)  similar  to 
beriberi,  which  likewise  can  be  arrested  or  prevented 
by  a  change  in  diet.  From  such  observations  the  con- 
clusion has  been  drawn  that  in  the  pericarp  of  the  rice 
grain  there  are  certain  substances  essential  to  the 
maintenance  of  health  and  that  their  withdrawal  from 
the  diet  leads  to  nutritional  disturbances.  The  name 
"vitamin"  has  been  given  to  these  substances,  but  little 
is  known  about  their  chemical  or  physiological  nature. 
In  a  varied  diet  vitamins  are  presumably  present  in  a 

'  E.  B.  Vedder,  Jour.  Amer.  Med.  Assoc,  LXVII  (1916),  1494. 


POISONING  OF  UNKNOWN  NATURE  103 

variety  of  foodstuffs,  but  if  the  diet  is  greatly  restricted, 
some  apparently  trivial  treatment  of  the  food  may 
result  in  their  elimination.  It  is  uncertain  how  many 
and  how  various  the  substances  are  that  have  been 
classed  by  some  writers  under  the  designation  vitamin. 
At  least  two  "determinants"  are  thought  to  be  con- 
cerned in  the  nutrition  of  growth,  a  fat-soluble  and  a 
water-soluble  substance.^ 

Pellagra  is  one  of  the  diseases  attributed  to  an 
unbalanced  diet,^  and  it  has  been  suggested  that  the 
increased  use  of  highly  milled  maize  and  wheat  flour 
from  which  vitamins  are  absent  may  be  responsible 
for  the  extension  of  this  malady  in  recent  years.  Other 
observers,  while  admitting  that  a  faulty  diet  may 
predispose  to  pellagra  as  to  tuberculosis  and  other 
diseases,  do  not  assent  to  the  view  that  it  is  the  primary 
factor.^ 

Lathyrism. — ^The  name  lathyrism  has  been  given 
to  a  disease  supposed  to  be  connected  with  the  use  of 
the  pulse  and  the  chick  pea.  Nervous  symptoms  are 
conspicuous  and  sometimes  severe,  although  the  affec- 
tion is  of  a  milder  type  than  pellagra.  The  disease  is 
said  to  be  associated  with  the  exclusive  or  almost 
exclusive  use  of  leguminous  food  and  with  generally 
miserable  conditions  of  living.  It  is  yet  uncertain 
whether  lathyrism  is  a  deficiency  disease  Uke  beriberi 
and  possibly  pellagra,  or  whether  it  is  due  to  a  mixture 
of   foreign   and   poisonous    seeds   with   the   particular 

'  McCoUura  and  Davis,  Jour.  Biol.  Chcm.,  XXIII  (1915),  181. 
'  Goldberger,  Jour.  Amer.  Med.  Assoc,  LXVI  (1916),  471. 
3  MacNeal,  Jour.  Amer.  Med.  Assoc,  LXVI  (1916),  975;   Jobling, 
Jour.  Infect.  Dis.,  XVIII  (1916),  501. 


I04  FOOD  POISONING 

legumes  consumed,  or  whether  under  certain  conditions 
the  legumes  themselves  may  contain  poisonous  sub- 
stances generated  by  some  unknown  fungus  growths. 

Favism  (from  fava,  "bean")  is  an  acute  febrile 
anemia  with  jaundice  and  hemoglobinuria  which  occurs 
in  Italy  and  has  been  attributed  to  the  use  of  beans  as 
food  or  even  to  smelling  the  blossom  of  the  bean  plant.^ 
A  marked  individual  predisposition  to  the  malady  is 
said  to  exist.  Although  the  symptoms  are  very  severe 
and  seem  to  point  to  an  acute  poisoning,  no  toxic 
substance  has  been  isolated  from  the  implicated  beans. 
It  has  been  suggested  by  some  that  bacterial  infection, 
and  by  others  that  a  fungous  growth  on  the  bean,  is 
responsible,  but  no  evidence  has  been  brought  forward 
to  support  either  assumption. 

Scurvy  in  some  forms  is  undoubtedly  connected  with 
the  lack  of  certain  necessary  components  of  a  normal 
diet.  The  development  of  scurvy  on  shipboard  in  the 
absence  of  fresh  milk,  fresh  vegetables,  fruit  juice,  and 
the  like  is  a  fact  long  familiar.  Guinea-pigs  fed  on 
milk,  raw  and  heated,  and  on  milk  and  grain  have 
developed  typical  symptoms  of  scurvy.^  On  the  other 
hand,  a  form  of  experimental  scurvy  has  been  produced 
in  guinea-pigs  and  rabbits  kept  on  an  ordinary  diet  of 
green  vegetables,  hay,  and  oats  by  the  intravenous 
injection  of  certain  streptococci.^  The  relative  share  of 
diet  and  infection  in  the  production  of  human  scurvy  is 
consequently  regarded  by  some  investigators  as  uncertain. 

'  Gasbarrini,  Polidinico,  November  14,  1915;  abstract,  Jour.  Amer. 
Med.  Assoc,  LXV  (1915),  2264. 

2  Hoist  and  Frolich,  Jour.  Hyg.,  VII  (1907),  619;  Moore  and  Jack- 
son, Jour.  Amer.  Med.  Assoc,  LXVII  (1916),  1931. 

3  Jackson  and  Moody,  Jour.  Infect.  Dis.,  XIX  (1916),  511. 


POISONING  OF  UNKNOWN  NATURE  105 

Rachitis  or  rickets  is  a  pathological  condition  in  some 
way  connected  with  a  protracted  disturbance  of  digestion 
which  in  turn  leads  to  faulty  calcium  metabolism.  It 
docs  not  seem  probable  that  rickets  is  caused  by  too 
little  calcium  in  the  food,  but  rather  by  the  inability  of 
the  bone  tissue  to  utilize  the  calcium  brought  to  it  in 
the  body  fluids.  Experiments  upon  the  causation  of  the 
disease  have  not  given  uniform  results,  and  it  does  not 
seem  possible  at  present  to  place  responsibility  for  this 
condition  upon  any  particular  form  of  diet,  such  as 
deficiency  of  fat  or  excess  of  carbohydrates  or  protein. 
It  appears  to  be  true  that  the  prolonged  use  of  any  food 
leading  to  nutritional  disturbance  causes  an  inability 
on  the  part  of  the  bone  cells  to  take  up  calcium  salts 
in  the  normal  manner. 

While  there  are  many  obscure  points  with  regard 
to  the  origm  of  both  scurvy  and  rickets,  there  is  no 
doubt  that  some  dietary  shortcoming  lies  at  their  base, 
and  that  they  can  be  cured  or  altogether  avoided  by 
maintenance  of  suitable  nutritional  conditions. 

THE   FOODS   MOST   COMMONLY   POISONOUS 

Certain  articles  of  food  figure  with  special  frequency 
in  the  reports  of  food  poisoning  outbreaks.  It  is  not 
clear  in  all  cases  why  this  special  liability  to  inflict 
injury  exists.  For  an  example,  vanilla  ice-cream  and 
vanilla  puddings  have  been  so  often  implicated  that 
some  investigators  have  not  hesitated  to  ascribe  a 
poisonous  quality  to  the  vanilla  itself.  But  there  is  no 
good  evidence  that  this  is  the  case,  and  it  has  been 
suggested  that  the  reducing  action  of  the  vanilla  favors 
the  growth  of  anaerobic  bacteria  which  produce  poison- 
ous substances,  an  explanation  highly  conjectural. 


io6  FOOD  POISONING 

The  conspicuous  frequency  with  which  the  consump- 
tion of  raw  meat  provokes  food  poisoning  has  already 
been  set  forth  and  in  large  part  explained  by  the  occa- 
sional derivation  of  meat  from  animals  infected  with 
parasites  harmful  to  man.  The  even  greater  culpability 
of  raw  inilk  is  due  to  the  fact  that  milk  is  not  only,  like 
meat,  sometimes  obtained  from  an  infected  animal,  but 
that  it  is  a  particularly  good  culture  medium  for  bacteria, 
and  in  the  process  of  collection  or  distribution  may 
become  infected  through  the  agency  of  a  human  carrier. 
Foods  such  as  ice-cream  that  are  prepared  with  milk 
are  also  often  connected  with  food  poisoning.  It  seems 
probable  that  illness  caused  by  ice-cream  is  much  more 
commonly  due  to  bacterial  infection  than  to  poisoning 
with  metals  or  flavoring  extracts.  The  responsibility 
of  these  latter  substances  is  entirely  problematic. 

Cases  of  cheese  poisoning,  which  apparently  are 
relatively  numerous,  are  of  quite  obscure  causation. 
Whether  such  poisoning  is  due  more  commonly  to  some 
original  contamination  of  the  milk,  or  to  an  invasion  of 
the  cheese  by  pathogenic  bacteria  in  the  course  of  prepa- 
ration, or  to  the  formation  of  toxic  substances  by  bacteria 
or  molds  during  the  process  of  ripening  which  the  cheese 
undergoes,  is  left  uncertain  in  the  majority  of  cases. 

Shellfish  poisoning  from  eating  oysters,  mussels, 
or  clams  is  unquestionably  caused  in  some  instances  by 
sewage  contamination  of  the  water  from  which  the 
bivalves  are  taken,  and  in  such  cases  bacilli  of  the 
typhoid  or  paratyphoid  groups  are  commonly  con- 
cerned. It  is  a  disputed  question  whether  certain 
recorded  outbreaks  of  mussel  poisoning  have  been  due 
to  bacterial  infection  or  whether  sometimes  healthy  or 


POISONING  OF  UNKNOWN  NATURE  107 

diseased  mussels  taken  from  unpolluted  water  contain  a 
poisonous  substance.  In  a  similar  way  it  is  uncertain 
whether  a  certain  marine  snail  {Murex  bradatus),  some- 
times used  for  food,  contains  under  certain  conditions  a 
substance  naturally  poisonous  for  man,  or  whether  it  is 
poisonous  only  when  it  is  infected  or  when  toxigenic 
bacteria  have  grown  in  it. 

Potato  poisoning  has  been  attributed  in  some  cases 
to  bacterial  decomposition  of  potatoes  by  proteus  bacilli; 
in  other  cases,  to  a  poisonous  alkaloid,  solanin,  said  to-be 
present  in  excessive  amounts  in  diseased  and  in  sprouting 
potatoes.  It  is  noteworthy  that  many  instances  of 
potato  poisoning  have  been  connected  with  the  use  of 
potato  salad  which  had  stood  for  some  time  after  being 
mixed,  so  that  the  possibility  of  infection  with  the 
paratyphoid  bacillus  or  other  pathogenic  organisms 
cannot  be  excluded.  That  solanin  is  ever  really  respon- 
sible for  potato  poisoning  is  considered  doubtful  by 
many  investigators. 

These  examples  are  sufficient  to  show  that  in  a  con- 
siderable proportion  of  cases  of  alleged  food  poisoning 
there  is  a  large  measure  of  uncertainty  about  the  real 
source  of  trouble.  Although  the  trend  of  opinion  has 
been  in  the  direction  of  an  increased  recognition  of 
the  share  of  certain  bacteria,  especially  those  of  the 
paratyphoid  group,  there  is  an  important  residue  of 
unexplained  food  poisoning  that  needs  further  skilled 
investigation.  It  is  one  of  the  objects  of  this  book  to 
point  out  this  need  and  to  draw  attention  to  the  numer- 
ous problems  that  await  settlement.  The  first  step  is 
the  regular  and  thorough  investigation  of  every  food 
poisoning  outbreak. 


INDEX 


A 

Acid  pickles,  33 

Adulteration,  food,  41 

Agglutination,  60,  64,  70 

Alkaloid,  107 

Allergy,  food,  6 

Almonds,  11 

Amanita:  aurantiaca,  20;  caesaria, 

18,   20;    muscaria,   18,    19,   20, 

22;     phalloides,     21,     22,     23; 

verna,  22 
"Amanita  toxin,"  22,  24 
Anaphylaxis,  9,  10,  11 
Aniline  dyes,  32 
Animal  parasites,  79 
Animals,  13,  14,  24,  44,  50,  67,  68, 

70,  71,  72,  78,  93,  95,  100,  106; 

emergency-slaughtered,   59,  62, 

63,  65,  72 
Ankylostomiasis,  83 
Annatto,  32 
"Anti-anaphylaxis,"  11 
Antimony,  27 

Antiseptic  chemicals,  33,  40 
Antitoxin,  24;  diphtheria,  9 
Appendicitis,  i 
Arsenic,  26,  loi 
Arteries,  3 
Artichokes,  16 
Ascaris,  84 
Asiatic  cholera,  50 
Asparagus,  30,  31 
Asthma,  10,  12 
Atropin,  20 


B 


Bacillus:  bolulinus,  g2~g6;  coli,  $6; 
Danysz,  75;  diphtheriae,  69;  en- 
tcritidis,  58,  59,  60,  63,  64,  65,  66, 
67,  68,  6g,  70,  71,  72,  74;  enteri- 
tidis-suipestifer,  70,  72;  paraly- 
phoid-enlcritidis,  68,  69,  85; 
paratyphosus,  58,  66;  paraty- 
phosus  B,  60,  65,  66,  73,  74;  pro- 
leus,  55,  56,  57,  107;  suipestifer, 
65,  66,  67,  68,  71,  72,  73,  74; 
tetanus,  69;  tubercle,  44,  51, 
52,  53;  typhoid,  44-47,  64, 
106 

Bacteria':  food-borne,  44,  58; 
pathogenic,  44,  58 

Bacterial  products,  85 

Balloon-fish,  24 

Barbel,  25 

Beans,  14,  31,  46,  86,  88,  95,  104 

Beef  stew,  59 

Beer,  26,  27 

Benzoate  of  soda,  34 

Benzoic  acid,  34,  35,  36 

Beriberi,  102 

Berries,  29,  35 

Birds,  game,  97 

Biscuits,  soda,  36 

Blood  vessels,  2,  39 

Borax,  37 

Boric  acid,  37,  38,  40 

Botulism:  86;  anatomical  lesions, 

91;  bacteriology,  92;  cases,  87; 

epidemiology,    93;     prevention 

and  treatment,  94;    symptoms, 

88 


109 


no 


FOOD  POISONING 


Bread,  47,  48 
Butter,  16,  32,  40,  loi 
Butyric  acid,  95 


Caffeine,  36,  41 

Cakes,  76 

"Calf  diarrhea,"  72 

Candies,  27,  28,  32,  41 

Canned  foods,  4,  5,  7,  8,  29,  30,  95 

Canning,  33,  93 

Cap,  metallic,  28 

Cardamom,  oil  of,  16 

Carriers,  55;  paratyphoid,  61,  62, 
66,  67,  70,  73,  78;  typhoid,  45, 
48,  so, 66 

Cases  of:  botulism,  87,  listed  by 
Mayer,  88,  in  U.S.,  88-91;  dys- 
entery, 84;  food  sensitization, 
10,  II,  12;  milksickness,  100; 
mushroom  poisoning,  20,  21,  22; 
plant  poisoning,  14;  poisoning 
from  asparagus,  30;  trichiniasis, 
80,  81;   tuberculosis,  53 

Cat,  83 

Cathartics,  96 

Cattle,  10,  51,  53,  54,  55,  62,  63,  71, 

72,  74,  82,  86,  96,  100 
Celery,  45,  46,  47 
Cereals,  12,  62 
Cestode  infection,  82 
Cheese,  5,  7,  28,  97,  106 
Chemicals,  antiseptic,  33,  40 
Chicken,  71,  88 
Chick  pea,  103 
Chicory,  41 
Chocolate,  28 
Cholera  microbe,  51 
Chopped  beef,  59 
Cicuta  maciilala,  14,  16,  17 
Cinnamon,  37 
Clams,  50,  106 


Claviceps:  paspali,  86;  purpurea, 
85,87 

Codiish,  67 

Coffee,  36,  41 

Coffee-tree,  14 

Coloring,  artificial,  40 

Coloring  substances,  31 

Conium  maciilatmn,  15 

"Contact  infection,"  62,  67 

Cook,  44,  45,  50,  73,  74 

Copper,  30,  loi 

Copper:  acetate,  31;  salts,  31;  sul- 
phate, 31,  32 

Cranberries,  35 

Creosote,  34 

Cyslicercus  ccllulosac,  82,  83 

D 

Daffodil  bulbs,  14 

Danysz  bacillus,  75 

Death  Camas,  14 

Death-cup,  21,  23 

Death-rates,  2,  3,  4,  39 

Delphinium,  14 

Diarrhea,  84 

Diet,  defective,  102,  103,  104,  105 

Diphtheria,  54 

Diseases:  deficiency,  loi;  degen- 
erative, 2;  milk-borne,  54;  skin, 
12 

Dog,  25,  83 

Drying,  zi,  4° 

Dyes,  anihne,  32 

Dysentery,  84 


Echinococcits,  83 
Eczema,  10,  12 
Eelworm,  84 

Eggs,  6,  10,  II,  12,97,98 
Egg-white,  9,  10,  II,  12 


INDEX 


III 


Epidemics.     See  Outbreaks 
Ergot,  85 
P>gotism,  85-86 
"Expectation  of  life,"  2 
Extracts,  flavoring,  106 


Favism,  104 

Fish,  s,  24,  25,  34,  62,  67,  71,  83 

Flies,  47 

Flour,  32,  43,  103 

"Fly  Amanila,"  18,  19,  21 

Fly  poison,  1 8 

Food:  adulteration,  41;  allergy, 
6;  coloration,  32;  intoxication, 
18,  57,  92;  preservatives,  33; 
substitutes,  16,  41 

Foods:  canned,  4,  5,  7,  8,  29,  30, 
95;  cooked,  47,  51,  52,  53,  54, 
60,63,69,70,78,81,94;  decom- 
posed, 39,  97;  most  commonly 
poisonous,  105;  protein,  sensiti- 
zation to,  9;  smoked,  34,  39; 
spoiled,  39,  97;  uncooked,  7,  46, 
47,  48,  55,  63,  69,  70,  79,  84, 
94,  96 

Foot-and-mouth  disease,  55 

Formaldehyde,  36,  40 

Fowl,  5 

Fruits,  5,  10,  29,  30,  35,  47,  50,  62, 
97,  104 

"Fruit  ethers,"  42 

Fruit  syrups,  42 

Fugii,  25 

Fungus,  85 


Gallstones,  i 
Game  birds,  97 

Gastro-enteritis,  56,  60,  74,  96 
Giardia  {Lamblia)  intestinaUs,  84 
Globe-fish,  24 
Glucose,  27,  41 
Goose,  71;  liver,  78 


Grain,  85,  104 
Grass,  wild,  86 
Gymnodadus  dioica,  14 

H 

llackilciscli,  59 

Ham,  86,  92,  94,  95 

Hamburger  steak,  59,  78 

Hay,  104 

Hay  fever,  g 

Heart,  3,  22 

Heating,  40 

Hellebore,  14 

Hemlock:     13,    15;     poison,    16; 

water,  14,  16,  17 
Hippuric  acid,  35,  36 
Hog  cholera,  66,  71 
Honey-locust,  14 
Hookworm  infection,  83 
Horse,  71,  86 
Horseradish,  16 
Hydatid  disease,  83 
Hydrocarpus,  16 
Hymenolcpis  nana,  82 


Ice,  75 

Ice  cream,  5,  7,  32,  105,  106 

Infection:  accidental,  72;  Asiatic 
cholera,  50;  Bacillus  prolcus(?) 
55;  bacterial  poisons,  86,  96 
carrier,  44,  45,  48,  50,  55,  61,  62 
66,  67,  70,  73,  78;  cestode,  82 
Giardia  {Lamblia)  intestinaUs 
84;  hookworm,  83;  laboratory, 
72;  milk-borne,  54;  parasitic 
79;  paratyphoid,  58;  scurvy 
104;  secondary  bacterial,  80 
soil,  46;  tapeworm,  82;  tubercu- 
lous meat,  51,  tuberculous  milk, 
53;  typhoid  food,  44 

Intoxication,  food,  18,  57,  92 

Iron  pyrites,  26 


112 


FOOD  POISONING 


Jams,  27 

Japanese  Fiigu,  25 
Jars,  preserve,  28 
Jelly,  32,  50 


Kalmla  lalifolia,  14 
Kidneys,  2,  3,  22,  24,  39 
Kittens,  84 


Larkspur,  14 

Lathyrism,  103 

Laurel,  14 

Lead,  27 

Lead:     chromate,    28;     foil,    28; 

pipes,  28;  salts,  29 
Legumes,  104 
Lettuce,  45,  50 
Liver,  22,  24;  goose,  78 
Loco-weed,  14 
Lupines,  14 

M 

Maize,  103  "         > 

Maratti-oil,  16 

Margarin,  16 

Marsh-marigold,  14 

Mary  Malloy,  45 

"Measly  pork,"  83 

Meat,  5,  7,  24,  33,  37,  40,  44,  51, 

52,  53,  57,  58,  59,  62,  63,64,  65, 
68,  69,  70,  71,  72,  75,  76,  77,  78, 
79,  83,  95,  97,  loi,  106;  jellies, 
69;  pies,  69,  73;   puddings,  69 

Meat  inspection,  77,  81 

Metals,  5,  106 

Mice,  56,  74,  75,  78,  84 

Milk,  5,  6,  7,  ID,  II,  40,  48,  50,  51, 

53,  54,  55,62,69,  70,  72,  73,  76, 
77,  96,  97,  loi,  104,  106 


Milksickness,  loo-ioi 
Molasses,  30 
Murex  hradalus,  107 
Muscarin,  22 
Mushrooms,  5,  13,  18-24 
Mussels,  50,  106 
"Mutations,"  68 

N 

Neuritis,  26 
"Neurotoxin,"  24 
Nipples,  rubber,  27 
Nissl  granules,  91 
Nitrogen  peroxide,  32 

O 

Oatmeal,  11 

Oats,  104 

Oil  of  cardamom,  16;  of  cloves,  37 

Olive  stones,  41 

Outbreaks  due  to:  beans,  Darm- 
stadt, 95,  Stanford  University, 
95;  beef,  Breslau,  58;  beef 
stew,  Limerick,  59;  beer,  Eng- 
land, 26;  bread,  Elgin,  48;  cod- 
fish, 67;  diseased  animals,  71; 
ergot,  Limoges,  85;  gastro- 
enteritis carrier,  74;  group  and 
family  in  U.S.,  4,  5;  ham,  Elle- 
zelles,  92;  human  contamina- 
tion, 73;  list  of,  by:  Hirsch,  85, 
Hiibener,  58,  Mayer,  65,  Savage, 
58;  margarin,  Hamburg,  16; 
meat,  65,  69;  Frankenhausen, 
63,  Ghent,  77;  meat  pies, 
Wareham,  73;  milk,  96;  Kristi- 
ania,  73,  Newcastle,  69;  miscel- 
laneous contaminations,  74; 
mushrooms.  New  York  City,  18; 
oysters,  48;  paratyphoid  car- 
rier, 73;  pie,  Westerly,  60; 
potato  salad,  65 ;  public  markets. 
South  Philadelphia,  46;  rat 
virus,  75 ;  sausage,  65;  Hanover, 
56,    Wiirttemberg,    86;     "sour 


INDEX 


"3 


grass  soup,"  New  York  City,  i8; 
spaghetti,  Hanford,  44;  typhoid 
carrier.  New  York  City,  45; 
Vanille  Pudding,  65 ;  vermicelli, 
67;  watercress,  Philadelphia, 
46;  water  hemlock.  New  Jersey, 
i6 
Oxalic  acid,  iS 

Oxyuria,  84 

Oysters,  5,  24,  48,  49,  50,  71,  106 


Palmolin,  16 

Pancolus  paplUonacctis,  21 

"  Paragaertner  "  forms,  68 

Parasites,  79,  84 

Parat}T3hoid  fever,  58-78;  carriers, 
61,  62,  66,  67,  70,  73,  78; 
diseased  animals,  67,  71;  gastro- 
intestinal, 61;  general  char- 
acters of,  61;  human  contamina- 
tion, 73;  means  of  prevention, 
77;  miscellaneous  contamina- 
tions, 74;  sources  of  infection, 
71;  symptoms,  61;  toxin  pro- 
duction, 68;  typhoid-like,  61; 
typical  outbreaks,  58 

Parrots,  72 

Parsnips,  16 

Pasteurization,  48,  54 

Pastry,  47 

Pate  de  foie  gras,  78 

Peas,  31,  43,  46 

Pellagra,  102,  103 

Pepper,  41 

Pericarp  of  rice,  102 

Peripheral  neuritis,  26 

Pickling,  93 

Pidan,  98 

Pie,  60 

Pigs,  71 

Pike,  25 

Pinworm,  84 

Plant  oils,  16 


Plants,  9,  13-24,  25,  loi 

Poisons:  bacterial,  96;  chemical, 
26;  mineral,  26;  organic,  26; 
protoplasmic,    2)2> 

Poisoning  by:  aniline  dyes,  32; 
animals,  24;  antimony,  27; 
arsenic,  26;  Asiatic  cholera  in- 
fection, 50;  Bacillus  prolcus{  ?) 
infection,  55;  botulism  intoxi- 
cation, 86;  coloring  substances, 
31;  copper,  30;  defective  diet: 
beriberi,  102,  favism,  104, 
lathyrism,  103,  pellagra,  103, 
rickets,  105,  scurvy,  104;  egg- 
white,  9;  ergot,  85;  fish,  25; 
food  preservatives,  t^t,;  food 
substitutes,  41;  lead,  27;  milk- 
borne  infections:  diphtheria, 
54,  foot-and-mouth  disease,  55; 
milksickness,  100;  scarlet  fever, 
54,  and  septic  sore  throat,  55; 
mushrooms,  18;  parasites,  ani- 
mal: teniasis,  82,  trichiniasis, 
79,  other,  84;  paratyphoid  in- 
fection, 58;  plants,  13;  shell- 
fish, 24;  tin,  29;  tuberculosis 
infection,  51;  typhoid  infection, 
44 

Poisoning,  food:  articles  of  food 
most  commonly  connected  with, 
7;  effects  of,  2;  extent  of,  3; 
frequency  of,  i;  kinds  of,  6; 
means  of  prevention,  2;  ob- 
scure, 100;  outbreaks  of,  in 
United  States,  3,  4,  5;  reports 
of,  3,  4,  8;  scope  of  book,  6; 
seasonal  incidence  of,  5;  un- 
known, 100 

Poison-ivy,  14 

"Poison  squads,"  34 

Pollen,  9 

Polyneuritis  of  fowls,  102 

Pork,  79 

Pork  and  beans,  88 

Potatoes,  46,  107 

Potato  salad,  65 

Preservatives:  chemical,  33;  food, 
33;  household,  37 

Proteins,  9,  11,  12,  62,  69,  80 


114 


FOOD  POISONING 


Protochloride  of  tin,  30 
"Ptomain  poisoning,"  1,3,18,1 

97 
Puffers,  24 
Pulse,  103 
Pyrites,  iron,  26 


Quinine,  3;^ 


R 


Rabbit,  71 

Rachitis,  105 

Radishes,  45 

Rash,  10,  12 

Rats,  56,  74,  75,  78,  81,  82 

"Rat  virus,"  75 

Refrigeration,  ^:i,  40 

Rice,  43,  102 

Ricin,  14 

Rickets,  105 

Ripening,  97 

Roundworm,  79 

"Royal  Amanita,"  18 

Rye,  8s 

S 

Saccharin,  41 

Salad,  s,  95,  107;   dressing,  95 

Salicylic  acid,  36 

Salt,  33,  41,  94 

Salt  solution,  33,  40 

Salting,  3,3 

Saltpeter  brines,  2,3 

Sandwiches,  46 

Saponin,  42 

Sausage,  5,  7,  40,  56,  65,  69,  75,  78, 

79,  86,  88 
Scarlet  fever,  54 
Scurvy,  55,  104 
Sensitization,  food,  6,  9 
" Septicl^sore  throat,"  55 


Serum,  antitoxic,  96;  blood,  11, 
64,  65,  70;   therapeutic,  9 

Shark,  25 

Sheep,  71, 100 

Shellfish,  10,  24,  106 

Shrimp,  71 

Smoking,  33,  93,  94 

Snail,  107 

"Soda  water,"  42 

Sodic  carbonate,  36 

Sodium  benzoate,  34 

Sodium  fluoride,  40 

"Soft  drinks,"  28,  42 

Soil,  infected,  46,  47 

Solanin,  107 

Solder,  28 

Sorrel,  18 

"Sour  grass  soup,"  18 

Sour  milk,  97 

Spaghetti,  44 

Spices,  37 

Staphylococcus,  96 

Stoppers,  patent  metal,  28 

Strawberries,  10 

"Streptococcus  sore  throat,"  55 

Strongyloides ,  84 

Strychnine,  33,  96 

Sturgeon,  25 

Substances,  coloring,  31 

Substitutes,  food,  16,  41 

Sugar,  26,  28,  41,  42 

Sugar  solution,  33,  40 

Sulphite,  36,  40 

Sulphurous  acid,  26,  27,  36 

Swine,  74,  80,  81,  82,  93 

Symptoms:  cholera-like,  25,  77; 
circulatory,  10;  coma,  22;  con- 
stipation, 89,  90,  100;  convul- 
sions, 20,  22,  25;  coryza,  10; 
diarrhea,  10,  21,  61,  90;  diffi- 
culty in  swallowing,  20;  digest- 
ive, I,  61,  105;  dizziness,  20, 
90;     eyelids,     edematous,     10; 


INDEX 


115 


febrile  anemia,  104;  fever,  6r, 
79;  gastro-intestinal,  i,  10,  58, 
61,  90;  hemoglobinuria,  104; 
jaundice,  104;  mental,  24; 
nausea,  10,  12,  88;  nervous,  10, 
24,  90,  103;  pain:  abdominal, 
21,  61,  89,  muscular,  79,  80; 
paralysis,  25,  96;  rapidity  of 
appearance  of,  10,  44,  58,  61,  91; 
rash,  10,  12;  sneezing,  10; 
temperature,  subnormal,  89, 
100;  thirst,  21,  89;  trismus,  20; 
visual,  20,  88,  89,  90,  91,  96; 
vomiting,  10,  12,  21,  88,  90,  100 
Syrups,  27,  42 


Tapeworm,  82,  83 
Tea,  36 

Tenia  saginata,  82 
Teniasis,  82 
Tenia  solium,  82 
Tetrodontidae,  24 
Theobromine,  36 
Tin,  29-30 
Tin  salts,  30 
"Toadstools,"  18 
Tomatoes,  12 
Toxin,  68 
Trembles,  100 
Trichina,  79 
Trichinella  spiralis,  79, 


Trichiniasis,  79 

Trichinosis,  79 

Tuberculin,  9 

Tuberculosis,  44,  51 

Typhoid  fever:  44-50,  78,  79;  car- 
riers, 45,48,  50,  66;  milk-borne, 
48 

U 

Uncinariasis,  83 

Urticaria,  10 

Utensils,  cooking,  27,  28,  30 

V 

Vanilla:     105;     ice    cream,    105; 

pudding,  65,  105 
Vegetables,  5,  29, 30,  31,  45,  46,  47, 

62,  83,  95,  97,  104 
Veralrum  viride,  14 
"Verdigris  poisoning,"  31 
Vermicelli,  67 
"Vitamin,"  102,  103 

W 

Water,  28,  50,  75 
Watercress,  45,  46 
Wintergreen,  14 


Zygadeniis,  14 


*^TrT'  '^"^'' 


UNIVERSITY  or  CALIFORNIA  LIBRARY 
BERKELEY 

Return  to  desk  f  ror.  which  "o"""-*. 
This  book  is  DUE  ott  the  last  date  statnpedbelow. 


liO®  C-dliiAltulAl' 


OCT 

3  0  1958 

FED 

2  01970 

FEB 

MAR  1  8  J983 

REC 

.  PUBL.  MAY  3    '83 

i^EC'D 

PUBUMi-  ^4^ 

LD21 


_100m-7.'52(A2528sl6)476 


U.C.  BERKELEY  UBRARIES 


CQETm4353 


